Physician Scientist Training in the United States: A Survey of the Current Literature

Perceptions of Research and Research-Oriented Careers Among College-Level Baccalaureate-MD Students in the United States

A survey was administered to describe research perceptions among college-level students in combined baccalaureate-MD (BA/MD) programs in the United States. Descriptive statistics were used to analyze participant research perceptions. The estimated response rate was 26% (430/1653). Most respondents conducted scientific research in high school and college and reported barriers to research participation. Key barriers to research participation included lack of time, research knowledge or experience, and sufficient research guidance as well as the disruptions of COVID-19. Most respondents reported that research-supporting programs were available at their institution and perceived faculty mentorship programs as the most helpful for broadening their research experience.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01619-5.

Medical research: what to expect in a student-supervisor relationship

BACKGROUND

A medical research supervisor is of crucial importance to the undergraduate student enrolled in a research methodology course. A solid relationship between the two is vital to the success of the research project and the overall well-being of the student. The structure of the relationship between a student and a research supervisor is seldom discussed in the context of undergraduate medical research. This study evaluates students' expectations of their research contributions and their supervisors' roles.

METHODS

This was an observational study in a large health university in Saudi Arabia. A total of 320 medical students enrolled in a two-year medical research program completed an online survey, of a previously validated instrument, that is, Role Perceptions Rating Scale. Demographic questions such as the current level in the research program (junior or senior) were added.

RESULTS

The results showed that most students expected the responsibility to be equally shared between the supervisor and student during the development and execution of the research project. Additionally, students expected the research supervisor to be responsible for the research themes and contents, ensuring access to facilities, and assisting in the actual writing of the final research manuscript. Furthermore, the results indicated differences in expectations between junior and senior students.

CONCLUSION

This study demonstrates that medical students expect their research supervisors to support them to a significant extent. Understanding medical students' expectations in a supervisor-student relationship is essential to successful research and collaboration. The evidence gathered in this study has practical implications for educational institutes to base their research training program on these insights. Providing clarity on the expectations and responsibilities of those participating in the research program is crucial, as this would, in turn likely advance the output of the research program and encourage clinicians to join the program as research supervisors.

A Clinician's Guide to Conducting Research on Causal Effects

Surgeons are uniquely poised to conduct research to improve patient care, yet a gap often exists between the clinician's desire to guide patient care with causal evidence and having adequate training necessary to produce causal evidence. This guide aims to address this gap by providing clinically relevant examples to illustrate necessary assumptions required for clinical research to produce causal estimates.

Early Outcomes of a New NIH Program to Support Research in Residency

The work of physician-investigators has historically led to key discoveries and developments in modern medicine, but recent decades have seen significant declines in the number of U.S. physician-investigators. One of the barriers to physicians participating in research is the lack of mentored research opportunities during clinical training, especially during residency training. In response to this identified barrier and to expand the physician-investigator workforce, the National Institutes of Health initiated the R38 program, known as Stimulating Access to Research in Residency, to support mentored research opportunities for residents. This article reports on the early outcomes of the recipients of the initial round of R38 awards, granted in 2018. Early positive outcomes include increases in the reported likelihood of resident-investigators pursuing physician-investigator careers, greater reported clarity in resident-investigators' research directions, the commitment of additional institutional resources to support the R38-awarded programs, and the approval of resident-investigators as having met training requirements for certification by multiple medical boards.

The Association of Attending Physicians' Publications and Patients' Readmission Rates: Evidence from Tertiary Hospitals in China Using a Retrospective Data Analysis

BACKGROUND

Physicians play a unique role in scientific and clinical research, which is the cornerstone of evidence-based medical practice. In China, tertiary public hospitals link promotions and bonuses with publications. However, the weight placed on research in the clinician's evaluation process and its potential impact on clinical practice have come under controversy. Despite the heated debate about physicians' role in research, there is little empirical evidence about the relationship between physicians' publications and their clinical outcomes.

METHOD

This paper examines the association of the quantity and quality of tertiary hospitals' attending physicians' publications and inpatient readmission rates in China. We analyzed a 20% random sample of inpatient data from the Urban Employee Basic Medical Health Insurance scheme in one of the largest cities in China from January 2018 through October 2019. We assessed the relationship between the quantity and impact factor of physicians' publications and 30-day inpatient readmission rates using logistic regression. There were 111,965 hospitalizations treated by 5794 physicians in our sample.

RESULTS

Having any first-author publications was not associated with the rate of readmission. Among internists, having clinical studies published in journals with an average impact factor of 3 or above was associated with lower readmission rates (OR = 0.849; 95% CI (0.740, 0.975)), but having basic science studies published in journals with an average impact factor of 3 or above was not associated with the rate of readmission. Among surgeons, having clinical studies published in journals with an average impact factor of 3 or above was likewise associated with lower readmission rates (OR = 0.708 (0.531, 0.946)), but having basic science studies published in journals with an average impact factor of 3 or above was associated with higher readmission rates (OR = 1.230 (1.051, 1.439)).

Le Double Cursus Santé Sciences à l’UFR Santé de Rouen

Le Double Cursus Santé Sciences (DCSS) permet de former précocement les futurs acteurs de santé à la recherche. La profonde transformation du système de santé et l’avènement de nouvelles techniques analytiques et numériques ont conduit à reconsidérer la place de la recherche dans la pratique clinique. L’expérience internationale de ce type de programme de formation, notamment aux États-Unis, a révélé le rôle prépondérant que jouent les acteurs de santé ayant acquis une double compétence, médicale et scientifique. En France, un DCSS précoce, pendant les études médicales, a été mis en place dans les années 2000. Cette formation reste cependant disparate et hétérogène, et ne concerne pas toutes les universités. En 2016, l’UFR Santé de Rouen a constaté que le nombre d’étudiants engagés dans ce double cursus était très faible, voire nul selon les années. Aussi, en 2017, un accompagnement institutionnel a été introduit. Celui-ci a abouti à la création d’un tutorat étudiant dédié à cette formation. Il a permis une augmentation du nombre de candidats intéressés et la reconnaissance institutionnelle de ce double parcours. Nous présentons ici les contours de cette formation impliquant étudiants et institution.

Tisch Cancer Institute Scholars Program: Mentored Cancer Research Training Pipeline for Medical Students

Cancer research has led to unprecedented advances in treatment in recent decades. Physician-scientists have played a crucial role in these advances given their unique perspective at the intersection between basic research and clinical care, though their representation in cancer research has been in progressive decline. Cancer research programs that feature strong mentorship at the medical student level are associated with increased likelihood of alumni choosing a cancer research career path. In an effort to increase the cancer research medical student training pipeline, senior research faculty from the Tisch Cancer Institute (TCI) at the Icahn School of Medicine at Mount Sinai (ISMMS) developed the TCI Scholars Program, a rigorous mentored research training program funding medical students' summer research. This program is currently in its third year and has garnered significant interest among mentors and students alike from all four TCI Cancer Center Support Grant (CCSG)-funded research programs. Herein, we describe the development, implementation, evaluation, and major outcomes of this program.

Mentoring Medical Education Research: Guidelines from a Narrative Review

Mentorship is critical to develop research scholars. Current literature provides mentorship guidance for biomedical research; however, mentorship for educational research is scarce. We explored literature to offer evidence-based guidance for medical education research mentors. A librarian searched peer-reviewed literature from 2001 to 2021 to identify guidelines for research mentors. Thirty-five articles were included in this narrative review. Our results identified attributes of mentors, overlapping roles, and barriers and benefits of mentoring. The structures and processes related to mentoring are reviewed and applicability to medical education research mentorship is summarized.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-022-01565-2.

Characteristics, barriers, and career intentions of a national cohort of LGBTQ+ MD/PhD and DO/PhD trainees

BACKGROUND

Lesbian, gay, bisexual, transgender, queer, non-binary, intersex, and/or asexual (LGBTQ+) individuals continue to suffer worse health outcomes compared to the general population. Data on LGBTQ+ individuals in medicine, particularly in medical training, remain sparse. National studies of LGBTQ+ students in MD/PhD and DO/PhD training programs have not been reported.

METHODS

Trainees pursuing MD, DO, MD/PhD, and DO/PhD degrees at 32 nationally representative institutions completed a 70-item survey about their future career and anticipated challenges using an online survey tool from September 2012 to December 2014. There were 4,433 respondents to the survey. Of those, 2,837 completed the gender identity questions and 2,849 completed the sexual orientation questions. Completion of these questions was required for inclusion. Survey results were analyzed to examine differences between LGBTQ+ and non-LGBTQ+ medical and dual degree trainees.

RESULTS

LGBTQ+ students were underrepresented among MD/PhD and DO/PhD trainees (8.70%) compared to the US population, though their representation was higher than among MD and DO trainees (5.20%). LGBTQ+ dual degree trainees endorsed the greatest interest in pursuing careers involving academic medicine, with varying career focuses including research, clinical duties, education, and advocacy. LGBTQ+ dual degree trainees prioritized opportunities in patient care, work-life balance, and research as the most important factors for their career selection. Importantly, a higher percentage of LGBTQ+ dual degree trainees (15.50%) identified sexual harassment as a past barrier to career advancement compared to their non-LGBTQ+ peers (8.27%). LGBTQ+ dual degree trainees were more likely to report having a mentor who advocated for them.

CONCLUSIONS

LGBTQ+ physician scientist trainees remain under-represented and under-studied. It is vital that medical institutions devote more time and resources towards identifying and addressing the unique needs of this group in training. Training programs should be aware of the current and prior challenges faced by their LGBTQ+ dual degree trainees, work to overcome the unique barriers they face, highlight the strengths and unique perspectives they bring, and foster their professional growth and goals during and beyond their training.

Leveraging the COVID-19 Research Spike to Provide Medical Students with Practical Experience in Data Appraisal and Grant Review

In April and May 2020, a group of students and professors from the Hackensack Meridian School of Medicine (HMSOM) created an elective to review pre-selected, de-identified COVID-19-related research proposals by physicians and researchers within the Hackensack Meridian Health (HMH) network. Students discussed and rated each proposal's significance, innovation, and approach using grading criteria that paralleled the National Institute of Health's (NIH) study section-based grant review process. In discussing these topics under the guidance of faculty with experience in writing and reviewing research grants, students gained a better understanding of what constitutes a quality research study and a compelling grant proposal.

Pearls of wisdom for aspiring physician-scientist residency applicants and program directors

Postgraduate physician-scientist training programs (PSTPs) enhance the experiences of physician-scientist trainees following medical school graduation. PSTPs usually span residency and fellowship training, but this varies widely by institution. Applicant competitiveness for these programs would be enhanced, and unnecessary trainee anxiety relieved, by a clear understanding of what factors define a successful PSTP matriculant. Such information would also be invaluable to PSTP directors and would allow benchmarking of their admissions processes with peer programs. We conducted a survey of PSTP directors across the US to understand the importance they placed on components of PSTP applications. Of 41 survey respondents, most were from internal medicine and pediatrics residency programs. Of all components in the application, two elements were considered very important by a majority of PSTP directors: (a) having one or more first-author publications and (b) the thesis advisor’s letter. Less weight was consistently placed on factors often considered more relevant for non-physician-scientist postgraduate applicants — such as US Medical Licensing Examination scores, awards, and leadership activities. The data presented here highlight important metrics for PSTP applicants and directors and suggest that indicators of scientific productivity and commitment to research outweigh traditional quantitative measures of medical school performance.

Creating a resident-centric rehabilitation research team

BACKGROUND

The 36-month Physical Medicine and Rehabilitation (PM&R) or Physiatry residency provides a number of multidisciplinary clinical experiences. These experiences often translate to novel research questions, which may not be pursued by residents due to several factors, including limited research exposure and uncertainty of how to begin a project. Limited resident participation in clinical research negatively affects the growth of Physiatry as a field and medicine as a whole. The two largest Physiatry organizations - the Association of Academic Physiatrists and the American Academy of Physical Medicine and Rehabilitation - participate in the Disability and Rehabilitation Research Coalition (DRRC), seeking to improve the state of rehabilitation and disability research through funding opportunities by way of the National Institutes of Health (NIH), the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) and the Patient-Centered Outcomes Research Institute (PCORI). A paucity of new Physiatry researchers neutralizes these efforts.

RESULTS

This paper details the creation of a novel, multidisciplinary Rehabilitation Resident Research program that promotes resident research culture and production. Mirroring our collaborative clinical care paradigm, this program integrates faculty mentorship, institutional research collaborates (Neuroscience Nursing Research Center, Neuroscience Research Development Office) and departmental resources (Shark Tank competition) to provide resident-centric research support.

CONCLUSIONS

The resident-centric rehabilitation research team has formed a successful research program that was piloted from the resident perspective, facilitating academic productivity while respecting the clinical responsibilities of the 36-month PM&R residency. Resident research trainees are uniquely positioned to become future leaders of multidisciplinary and multispecialty collaborative teams, with a focus on patient function and health outcomes.

Facilitating Success of the Early Stage Surgeon Scientist Trainee: Growing the Surgeon Scientist Pipeline

OBJECTIVE

Surgeon scientists bring to bear highly specialized talent and innovative and impactful solutions for complicated clinical problems. Our objective is to inform and provide framework for early stage surgeon scientist training and support.

SUMMARY OF BACKGROUND DATA

Undergraduate, medical student, and residency experiences impact the career trajectory of surgeon scientists. To combat the attrition of the surgeon scientist pipeline, interventions are needed to engage trainees and to increase the likelihood of success of future surgeon scientists.

METHODS

A surgery resident writing group at an academic medical center, with guidance from faculty, prepared this guidance document for early stage surgeon scientist trainees with integration of the published literature to provide context. The publicly available National Institutes of Health RePORTER tool was queried to provide data salient to early stage surgeon scientist training.

RESULTS

The educational path of surgeons and the potential research career entry points are outlined. Challenges and critical supportive elements needed to inspire and sustain progress along the surgeon scientist training path are detailed. Funding mechanisms available to support formal scientific training of early stage surgeon scientists are identified and obstacles specific to surgical careers are discussed.

CONCLUSIONS

This guidance enhances awareness of essential education, communication, infrastructure, resources, and advocacy by surgery leaders and other stakeholders to promote quality research training in residency and to re-invigorate the surgeon scientist pipeline.

The Yin and the Yang of Transformative Research During the COVID-19 Pandemic-A Perspective

The COVID-19 pandemic has highlighted the necessity for scientists from diverse disciplines to collaboratively mitigate the singular calamity facing humanity this century. The ability of researchers to combine exponential advances in technology and scientific acumen has resulted in landmark discoveries in pediatric research and is surmounting the COVID-19 challenge. Several of these discoveries exist in a realm of research that is not classically "basic" or "clinical." Translational research characterizes this domain partially, but does not fully capture the integrated research approaches that have spurred these discoveries. Herein, we share our perspective on the common themes underpinning the basic and clinical research. We also highlight major differences in the scope, emphasis, approach, and limitations of basic and clinical research that impede multi-disciplinary approaches that facilitate truly transformative research. These differences in research thinking and methodology are ingrained during training wherein the limitations of the chosen discipline, and strengths of alternate disciplines are not adequately explored. Insular approaches are particularly limited in impacting complex diseases pathophysiology in the era of precision medicine. We propose that integration of -omics technologies, systems biology, adaptive clinical trial designs, humanized animal models, and precision pre-clinical model systems must be incorporated into research training of future scientists. Several initiatives from the NIH and other institutions are facilitating such broad-based "research without frontiers" training that paves the way for seamless, multi-disciplinary, research. Such efforts become "transformative" when scientific challenges are tackled in partnership with a willingness to share ideas, tackle challenges, and develop tools/models from the very beginning.

Barriers and potential solutions to international collaboration in neuro-oncology clinical trials: Challenges from the Australian perspective

AIM

The neuro-oncology community in Australia is well positioned to collaborate internationally, with a motivated trials group, strong regulatory bodies and an attractive fiscal environment. We sought to identify gaps in the Australian neuro-oncology clinical trials landscape and describe strategies to increase international trial access in Australia.

METHODS

We searched clinical trial registries to identify active adult primary brain cancer trials. We compared the participation rate and phase of these trials between tumour types and countries. A survey was distributed to the Cooperative Trials Group for Neuro-Oncology membership to identify barriers and solutions to effective international collaboration.

RESULTS

Globally, 307 trials for adult primary brain cancers were identified. These included 50% pharmaceutical agents, 18% cellular therapies and 9% radiation therapy. Twelve adult primary brain cancer trials were actively recruiting in Australia at the time the survey was sent out. There were more early phase brain cancer trials (34%) compared with colorectal and breast cancer (21% and 24%, respectively). In Australia, 92% of brain cancer trials were involving pharmaceutical agents. The most commonly cited barrier was lack of funding for international trials (86%) and insufficient research time (75%). High ranking solutions included increasing the availability of funding for international trials and creating opportunities to develop personal relationships with collaborators. Accreditation of clinical research key performance indicators into practice (88%) and hospital accreditation (73%) also ranked highly.

CONCLUSIONS

Participation in international research in Australia could be improved by embedding clinical research targets into institutional funding, provision of funding for early phase studies and streamlining mutual ethics schemes.

The MD-PhD program in Geneva: a 10-year analysis of graduate demographics and outcomes

BACKGROUND

MD-PhD programs confer degrees that empower medical doctors with in-depth scientific skills to contribute to biomedical research and academic medicine, alongside clinical practice. Whilst the career options and research opportunities related to graduates following these programs in the US are well documented, little is known about their European counterparts. In this article, we studied graduates who had completed the MD-PhD program at the University of Geneva between 2010 and 2019.

METHODS

A cross-sectional survey was performed in April 2019, targeting all medical doctors who had obtained the MD-PhD degree from the University of Geneva since 2010. Demographics, opinions, and career outcomes of the MD-PhD graduates were assessed through an online anonymous questionnaire.

RESULTS

Twenty-one questionnaires were collected from 31 MD-PhD graduates (response rate 65.5%). Most respondents (57.1%) had performed an MD-PhD training in basic sciences; however, only 14.3% had pursued this type of research thereafter. Most of the respondents held a position at a University hospital (90.5%), although a significant number of them were no longer involved in research in their current position (28.6%). 85.7% mentioned obstacles and challenges in combining clinical duties with research. Despite this, the majority (85.7%) declared that the MD-PhD degree had given them advantages in their career path, granting access to clinical and academic positions, as well as funding.

CONCLUSIONS

Graduates from the MD-PhD program in Geneva were for the most part, satisfied with their training. However, because of the challenges and obstacles in combining clinical duties with research, the implementation of research activities in their current position proved difficult.

The Highly Structured Physician Scientist Training Program (PSTP) for Medical Students at the University of Pittsburgh

The University of Pittsburgh School of Medicine Physician Scientist Training Program (PSTP) is a 5-year medical student training program designed to prepare the next generation of MD-only physician-scientists engaging in preclinical research. This article provides an overview of the program, including the novel longitudinal structure and competency goals, which facilitate success and persistence in a laboratory-based physician-scientist career. The authors present data on 81 medical students accepted to the program from academic year 2007-2008 through 2018-2019. Extrinsic outcomes, such as publications, grant funding, and residency matching, indicate that PSTP trainees have actively generated research deliverables. A majority of eligible PSTP trainees have earned Howard Hughes Medical Institute Medical Research Fellow funding. PSTP students have produced a mean of 1.6 first-authored publications (median, 1.0) and a mean of 5.1 total publications (median, 4.0) while in medical school and have authored 0.9 publications per year as residents/fellows, excluding internship. Nearly 60% of PSTP students (26/46) have matched to top-10 National Institutes of Health-funded residency programs in their specialty (based on Blue Ridge Institute rankings). PSTP alumni are twice as likely as their classmates to match into research-heavy departments and to publish first-authored papers. Results of a 2018 program evaluation survey indicate that intrinsic outcomes, such as confidence in research skills, significantly correlate with extrinsic outcomes. The program continues to evolve to maximize both scientific agency and career navigation skills in participants. This medical student PSTP model has potential to expand the pool of physician-scientist researchers in preclinical research beyond the capacity of dedicated MD-PhD and postgraduate training programs.

Developing Future Academic Physicians: the Academic Medicine Scholars Program

Retention among academic medicine faculty is problematic, and there has been a decline in the number of physicians pursuing careers in academia. The education of future physicians relies upon physicians who pursue careers in academic medicine. Therefore, efforts must be taken to increase the percentage of physicians who conduct research and/or teach medical trainees. Recognizing this need, the New York Institute of Technology College of Osteopathic Medicine (NYITCOM) established the Academic Medicine Scholars Program ("Scholars Program"), which was designed to prepare outstanding osteopathic medical students for a career in academic medicine. Here we aim to determine the extent to which participants in NYITCOM's Scholars Program go on to pursue research and teaching endeavors during their residency and/or fellowship programs. An anonymous survey was administered to participants in the Scholars Program from 2012 through 2018 and asked about the participants' research and teaching experiences at the following time points: during the Scholars Program, residency, and fellowship, if applicable. Participation in the program led to a significant increase in survey respondents' teaching and research skills and an increased participation in scholarly activity as compared with the national average. The results also demonstrated that the program assisted alumni in securing positions in competitive residency and fellowship programs. As residents and fellows, alumni continued to pursue scholarly endeavors, primarily by publishing abstracts and posters, attending both regional and national conferences, and delivering lectures. We are hopeful that other medical schools will take part in producing capable academic medicine physicians by incorporating a similar program into their curriculum.

Lack of Additional Advanced Graduate Training by Orthopaedic Surgeons in Academic Practice: Current Employment and Recruitment Trends

Background:

Orthopaedic surgery is ever changing and depends on diverse technical and intellectual skill sets. The purpose of the current study was to evaluate the percentage of academic orthopaedic surgeons with additional graduate degrees in the United States.

Methods:

Data including advanced degree(s) (eg, PhD, MS, MBA, MPH, JD, and DVM), academic rank, leadership position, subspecialty, years since training completion, and sex were collected from websites for all academic orthopaedic surgery departments in the United States. Univariate analyses were performed to evaluate for differences in demographic data based on the advanced degree status. Data from the National Resident Matching Program (NRMP) were used to characterize graduate degree-holding US senior medical students who ranked orthopaedic surgery first relative to peers without additional advanced degrees and to applicants who ranked other specialties first.

Results:

Of 4,519 faculty at 175 academic orthopaedic surgery departments in the United States, 7.1% held a graduate degree in addition to a medical doctorate. There was no difference in the percentage of faculty who held departmental leadership positions (P = 0.62) or who were full professors (P = 0.66) based on holding an additional graduate degree. Of 678 US senior applicants who ranked orthopaedic surgery first and successfully matched into the specialty in 2018, 12.5% held an additional graduate degree and 1.3% were MD-PhDs. Orthopaedic surgery had the second lowest percentage of matched medical students with additional advanced degrees, which was significantly lower than the top 10 specialties (range 16.1% to 21.6%; P < 0.05). Orthopaedic surgery recruited 1.6% of all MD-PhD applicants in 2018.

Discussion:

Few academic orthopaedic surgery faculty and admitted orthopaedic residency candidates have additional graduate school training. The low percentage of orthopaedic faculty and trainees with additional advanced degrees relative to other specialties may represent a missed opportunity to recruit individuals with diverse skills to advance the field of orthopaedic surgery.

Would you do it again? A qualitative study of student and supervisor perceptions of an intercalated MBChB/PhD programme

BACKGROUND

Several studies have warned about the diminishing physician-scientist breed. Limited studies, however, have attempted to assess what factors (if any) enhanced or hindered the experience of trainee physician-scientists and their supervisors. Using Vroom's expectancy theory as a conceptual framework, we explored the highlights, motivations and barriers of an intercalated MBChB/PhD programme as experienced by students of the programme and their supervisors.

METHODS

Previous and current students of the MBChB/PhD programme at the University of Otago, and their supervisors, were invited to provide comments on the programme. Data were analysed using a general inductive approach which involved coding responses, and grouping codes into common themes via an iterative process. A deductive approach was used to interpret the themes and relate them to Vroom's expectancy theory.

RESULTS

A total of 22 students (88% response rate) and 36 supervisors (58.3% response rate) responded to our survey. Three themes were identified through the analysis of the students' responses. These were: motives for undertaking the intercalated degree, effect on career development, and perceived barriers. Supervisors' survey yielded two themes: characteristics of successful students, and optimising the intercalated programme.

CONCLUSIONS

The current study sheds light on the successes and challenges of an intercalated MBChB/PhD programme by considering the views of those most involved. Whereas the combined programme has its advantages for student research and career development, extending the research-time may be worthwhile. Further studies involving a larger cohort of intercalating students and their supervisors may allow for extrapolation of data to address these concerns.

Distribution and retention trends of physician-scientists in Japan: a longitudinal study

BACKGROUND

Physician Scientists (PSs) play a significant role in medical science because of their clinical practice and research expertise. Although it is important to analyze the distribution and retention trends in the number of PSs in Japan, research on this topic has been insufficient. Thus, the purpose of this study is to analyze PSs distribution and retention trends, identify factors related to their retention, and consider the policy implications.

METHOD

I analyzed individual data from 1996 to 2016 from a national census survey that had been administered by the national government of Japan every 2 years. The number of PSs in 1996 and 2016 were 4930 (2.1% of all physicians) and 5212 (1.6%), respectively. I conducted a descriptive analysis and identified retention trends. I then used a multivariable logistic regression analysis to identify the factors related to the retention of PSs.

RESULTS

Between 1996 and 2016, the total number of PSs in Japan increased by 6%. The number of PSs aged 39 years or younger decreased by 48%, while those aged between 55 and 69 increased by 91%, indicating a notable decrease in the number of PSs under the age of 39. From 2014 to 2016, the annual retention rate of PSs was estimated to be 75.5%, which represented a low and stable rate compared to other physicians over the study period. The odds of continuing to practice as a PS were significantly higher for those who have between 15 to 29 years of experience after qualification as a physician.

CONCLUSION

This study indicates that it is likely for the total number of PSs to decrease in the future. Although the Japanese government has implemented various measures to retain PSs, these have not been effective. Possible new interventions to address this problem include increasing the knowledge of medical students and younger physicians of the role of PSs and the benefits of a career as a PS, providing specific career paths for PSs, securing specific positions for PSs, and increasing the compensation for PSs.

The national MD-PhD program outcomes study: Relationships between medical specialty, training duration, research effort, and career paths

MD-PhD programs were established in the 1950s as a new curriculum for training physician-scientists. Since then, the number of programs has grown considerably; however, concerns about the health of the US physician-scientist workforce have grown, as well. The largest attempt to date to assess whether MD-PhD programs are fulfilling their mission was the national MD-PhD program outcomes study, which was released as an American Association of Medical Colleges report in 2018. That study gathered information on 10,591 graduates of 80 MD-PhD programs over 50 years and concluded that most graduates have followed careers consistent with their training. Here, we provide additional analysis, drawing on survey data provided by 64.1% of alumni (75.9% of alumni with valid email addresses), plus program-supplied current workplace data for survey nonresponders to examine the relationships between medical specialty choices, training duration, research effort, and success in obtaining research funding. The results show that residency choices affect critical aspects of the physician-scientist career path, including where graduates work, how long it takes them to obtain an independent appointment in academia, and the amount of their professional time that is devoted to research. Entrants into MD-PhD programs are older, on average, now than when the programs were first established and are taking longer to graduate and complete postgraduate training. Although we found a positive relationship between professional effort devoted to research and the likelihood of having research funding, we found little evidence that the increase in training duration produces an increase in subsequent research effort. These data should provide both guidance for anyone considering this career path and insights for those who train and hire the next generation of physician-scientists.

Critical Gaps in Understanding the Clinician-Scientist Workforce: Results of an International Expert Meeting

Clinician-scientists-health care professionals expert in research and clinical practice-can play a vital role in translating research outcomes to clinical practice. Concerns about the sustainability of the clinician-scientist workforce have been expressed in the literature for decades. Although many have made recommendations to increase the clinician-scientist workforce, there has been no substantial change. Therefore, an international expert meeting was held in March 2017 in Utrecht, the Netherlands, with the goal of discovering unidentified gaps in our understanding of challenges to the sustainability of the clinician-scientist workforce. Nineteen individuals (steering committee members; representatives from the AAMC, AFMC, and RCPSC; and physician-scientists, nurse-scientists, education scientists, deans, vice deans, undergraduate and postgraduate program directors, and a medical student) from Canada, the Netherlands, the United States, and Singapore participated in the meeting. The meeting identified 3 critical questions to be addressed: (1) What is the particular nature of the clinician-scientist role? (2) How are clinician-scientists to be recognized within the health and health research ecosystem? and (3) How can the value that clinician-scientists add to translational medicine and research be clarified to stakeholders and the public? The meeting participants identified a 3-fold agenda to address these questions: articulating the value proposition of clinician-scientists, supporting professionalization and professional identity development, and integrating clinical and research training. Addressing the 3 critical questions will likely contribute to a wider recognition of the value of clinician-scientists and be a first step in advancing from recommendations toward system-level changes to reinvigorate the clinician-scientist workforce.

Future Directions of Training Physician-Scientists: Reimagining and Remeasuring the Workforce

In academic medicine, the attrition of the physician-scientist workforce has been significantly discussed for the past three decades, with substantial attention and funding targeted to stop this attrition and attempt to reinvigorate the workforce. Despite these concerns and efforts, the attrition has not been stopped or even significantly slowed, and thus a further understanding of the physician-scientist workforce is needed with a closer look at how this workforce is measured and quantified. Through reviewing three methods by which physician-scientists are identified and understood, limitations in these definitions arise, leading to the basic question: Who qualifies to be a physician-scientist? Answering this question may lead to developing more comprehensive and less restrictive approaches when qualifying and measuring the physician-scientist workforce and appreciating the varying contributions physicians make to research. Through suggesting an expanded appreciation of these research contributions, recognition of collaboration, and funding models that support both of these aspects, the authors hope to add to the conversation by challenging traditional approaches and encouraging movement toward forward-looking definitions that encourage and promote all physicians to engage with research. This reimagining of physician-scientists will result not just in a remeasuring of the workforce but, subsequently, in strengthening the clinical and translational research continuum as well.

Academic medicine: the continuing challenges

BACKGROUND

Numbers of academic medicine trainees have been declining internationally. Many countries have taken differing approaches to improving recruitment, with some having established pathways. In the UK, the academic foundation programme (AFP) is one such pathway aimed towards those interested in an academic medical career. Variation exists amongst universities with respect to application and success rates. As a group of AFP doctors, we aimed to explore these issues. Numbers of academic medicine trainees have been declining internationally METHODS: We created and implemented a 1-day national course, comprising lectures and small group workshops, geared towards informing applicants about the AFP. It was evaluated via pre- and post-course questionnaires using a Likert scale, ranging from 1 to 5. We created and implemented a 1-day national course, comprising lectures and small group workshops, geared towards informing applicants about the AFP RESULTS: A total of 150 attendees were present from 16 different medical schools; 95% (143/150) of the attendees filled in both questionnaires. Attendees appeared unaware of the stages involved in the application process and felt underprepared. Following the course, learners reported median scores (with interquartile limits) that demonstrated increased overall knowledge, from 2 (1) to 4 (1) (p < 0.01), and increased preparedness, from 2 (1) to 3 (1) (p < 0.01).

DISCUSSION

Our findings indicate that recruitment remains challenging, even in countries with established pathways. In the UK, the awareness of these pathways appears to be poor and courses such as ours may remedy that. Further exploration into the most effective methods to increase recruitment is necessary. The effect of institutional disparities in research culture and impact on application success needs investigation. Perhaps medical schools should introduce students to the prospect of academic careers earlier in training. Globally, efforts still need to be concentrated largely towards establishing integrated pathways.

Preventing Translational Scientists From Extinction: The Long-Term Impact of a Personalized Training Program in Translational Medicine on the Careers of Translational Scientists

Far too much biomedical research is wasted and ends in the so called "Valley of Death": the gap that exists between biomedical research and its clinical application. While the translational process requires collaboration between many disciplines, current translational medicine focuses on single disciplines. Therefore, educational pathways that integrate clinical and research skills in interdisciplinary and interprofessional contexts are needed. The Eureka institute (http://www.eurekainstitute.org/) was founded to address these issues. The institute organizes an annual 1-week international certificate course to educate professionals in the domains of translational medicine. Study design: This study set out to investigate the impact of the Eureka certificate course on the alumni, focusing on their ability to engage in translational activities and thus become more proficient translational professionals. An explanatory, mixed-methods study was executed. Data collection: A questionnaire was distributed to collect quantitative data on the number of alumni who were able to apply what they learned during the Eureka course and engage in translational activities. Questionnaire data were also used to inform the semi-structured interviews that were conducted subsequently. Results: Fifty-one percent of the alumni reported that participating in the Eureka course played a role in their decision to change to a different job or in the way they were accomplishing their everyday work. Ten conditions for change that either hampered or supported the Eureka alumni's engagement in translational research activities were identified. Further, the learning outcomes of the Eureka course that impacted the alumni's professional activities were explored using Personal Professional Theory (PPT). The insight that alumni gained in the full translational spectrum and stakeholders involved stimulated reflection on their own role within that pathway. Further, according to the alumni, the course provided them with the skills and confidence to pursue a career as translational professional. These learning outcomes, in combination with conditions that supported alumni's engagement in translational activities, such as supportive professional partners, opportunities to network or collaborate, and a translational work environment, contributed to the large number of alumni that were able to engage in translational activities.

The dentist-scientist career pathway in Africa: opportunities and obstacles

The future of evidence-based dentistry in developing Africa heavily depends on a sustainable establishment of a vibrant dentist-scientist workforce. A dentist scientist is saddled with the responsibility of carrying out robust cutting edge research projects that are inspired by clinical experience. Currently, there are no pipelines in place to systematically train such dentists, neither are there programs in place to allow trained African dentists choose such a career pathway. A dentist-scientist is a person who studied oral, dental, maxillofacial (or craniofacial) diseases, prevention, and population sciences (obtaining a medical degrees such as bachelor of dental surgery [BDS] or BChD) alone; or in combination with other advanced degrees such as doctor of dental surgery (DDS)/doctor of philosophy (PhD) or BDS/PhD. This situation has resulted in overdependence of African clinical practice on research findings from technologically advanced Western countries and a decline in clinical research capacity building. The career path of a dentist-scientist should involve research along the spectrum of basic biomedical sciences, translational, clinical and public health sciences. There are several factors responsible for the ultra-low count of dentist-scientist in the heterogeneous African communities such as: poor biomedical research infrastructure; lack of funding; absence of structured dentist scientist career pathways; lack of personnel, inter alia. Hence, this review hopes to discuss the opportunities of setting up a dentist-scientist training pathway in Africa (as obtains in most developed world settings), identify opportunities and prospects of developing an African dentist-scientist workforce, and finally discuss the challenges involved.

Future physician-scientists: could we catch them young? Factors influencing intrinsic and extrinsic motivation for research among first-year medical students

INTRODUCTION

The medical field is currently facing a physician-scientist shortage. One possible solution is to direct medical students towards a research oriented career. To do so, knowledge is needed on how to motivate medical students to do research. Therefore, this study examines motivation for research and identifies factors influencing intrinsic and extrinsic motivation for research among first-year medical students.

METHODS

First-year medical students were surveyed at the beginning of their bachelor's program in 2016. On a 7-point Likert scale, students reported their motivation for research, self-efficacy, perceptions of research, curiosity, and need for challenge. Regression analyses were used to examine the influence of these factors on students' motivation for research.

RESULTS

Out of 316 approached students, 315 participated (99.7%). On average, students scored 5.49 on intrinsic, and 5.66 on extrinsic motivation for research. All factors measured influenced intrinsic and extrinsic motivation for research significantly and positively, also after adjusting for gender and age. Cumulative regression showed that these factors explained 39.6% of the variance in intrinsic, and 14% in extrinsic motivation for research.

DISCUSSION

All factors play an important role in intrinsic and, to a lesser extent, extrinsic motivation for research. First-year medical students' motivation for research could be enhanced by stimulating positive self-efficacy beliefs, positive perceptions of research, and curiosity. Also, it is important to fulfil students' needs for challenge by stimulating them to actively conduct research. Thus, to catch students young and cultivate physician-scientists, students should be stimulated to engage in research from the beginning of medical training.

Integrating basic science in academic cardiology training: two international perspectives on a common challenge

Political bodies and professional societies acknowledge that translational research benefits from researchers trained in both, clinical medicine and basic science. Yet, few physicians undergoing clinical training in cardiology seek this dual career (Milewicz et al. J Clin Invest 125:3742–3747, 2015). The reasons are likely manifold, but with cardiology having become increasingly interventional and facing economic pressure, how much attention, credit, and encouragement is given to physicians interested in basic cardiovascular science? Having studied and worked in hospitals and laboratories, in both Germany and the USA, we aim to compare in this article how basic science education is currently integrated into cardiology training at German and US university hospitals, from medical school to more advanced career stages. By doing so, we hope to provide some outside perspectives to young physicians and decision makers alike, that may inspire changes to curricula in the respective countries and around the world.

Using an Extracurricular Honors Program to Engage Future Physicians Into Scientific Research in Early Stages of Medical Training

Physician-scientists are urgently needed to make progress in the dynamic world of medical healthcare. Currently, there is a worldwide shortage in physicians pursuing a scientific career. Actively engaging students in research in early stages of medical training could help to direct students towards a scientific career and contribute to creating the next generation of physician-scientists. Leiden University Medical Center (LUMC) implemented an extracurricular Honors program with a fundamental orientation towards research. The program starts in the second year of medical training and is comprised of four different tracks in order to attract multiple types of students with different interests. All four tracks offer students scholarly experiences, but differ in content and amount of provided structure. The LUMC Honors program has a clear goal to develop future physician-scientists, and combined with its unique multiple-track model, the program accommodates about 70 students (25%) each year. The number of students in the program has grown and students' experiences are positive.

The Rising Challenge of Training Physician-Scientists: Recommendations From a Canadian National Consensus Conference

Physician-scientists are individuals who actively participate in patient care, have undergone additional research training, and devote the majority of their time to research. Physician-scientists are traditionally the primary catalysts in bridging the translational gap-that is, the failure to link fundamental new knowledge in the pathobiology of disease with advances in health care and health policy in a timely manner. However, there has been a shift away from training physician-scientists, and financial support for the physician-scientist is diminishing globally, causing the translational gap to grow. Given its socialized health care system and cultural and geographic diversity, Canada can serve as a unique case study in understanding how to address this phenomenon as a national priority. To this end, a Canadian national consensus conference was convened to develop recommendations for training programs and early-career supports for physician-scientists. Five recommendations were generated: (1) Establish an independent, national council whose mandate is to provide pan-Canadian oversight of physician-scientist training programs; (2) develop capacity for funding and mentorship support for physician-scientists; (3) develop coherent networks across a broad range of clinician-scientists, including physician-scientists, to reflect the unique cultural and geographic diversity of Canada and to reflect the interdisciplinarity of health research; (4) ensure that medical school curricula integrate, as a core curriculum feature, an understanding of the scientific basis of health care, including research methodologies; and (5) ensure that the funding of the physician-scientist trainee is viewed as portable and distinct from the operational funding provided to the training program itself.

Training the next generation of physician researchers - Vanderbilt Medical Scholars Program

BACKGROUND

As highlighted in recent reports published by the Physician-Scientist Workforce Working Group at the National Institutes of Health, the percentage of physicians conducting research has declined over the past decade. Various programs have been put in place to support and develop current medical student interest in research to alleviate this shortage, including The Vanderbilt University School of Medicine Medical Scholars Program (MSP). This report outlines the long-term program goals and short-term outcomes on career development of MSP alumni, to shed light on the effectiveness of research training programs during undergraduate medical training to inform similar programs in the United States.

METHODS

MSP alumni were asked to complete an extensive survey assessing demographics, accomplishments, career progress, future career plans, and MSP program evaluation.

RESULTS

Fifty-five (81%) MSP alumni responded, among whom 12 had completed all clinical training. The demographics of MSP alumni survey respondents are similar to those of all Vanderbilt medical students and medical students at all other Association of American Medical College (AAMC) medical schools. MSP alumni published a mean of 1.9 peer-reviewed manuscripts (95% CI:1.2, 2.5), and 51% presented at national meetings. Fifty-eight percent of respondents reported that MSP participation either changed their career goals or helped to confirm or refine their career goals.

CONCLUSIONS

Results suggest that the MSP program both prepares students for careers in academic medicine and influences their career choices at an early juncture in their training. A longer follow-up period is needed to fully evaluate the long-term outcomes of some participants.

CanMEDS scholars: A national survey on urology residents' attitudes towards research during training

INTRODUCTION

Participation in scholarly activity is an important tenet of residency training and is firmly entrenched in Canada since the introduction of CanMEDS roles by the Royal College of Physicians and Surgeons. As Canadian residency programs transition to competency-based training, it will remain important to understand how to best implement and encourage scholarly pursuits among resident trainees. The objective of this study was to understand the experiences, attitudes, and barriers that surgical residents face when pursuing research during their training.

METHODS

An anonymous, cross-sectional, self-report questionnaire was administered to chief residents of all English-speaking urology programs in Canada in 2015. Questions were open- and close-ended, including an agreement score based on a five-point Likert scale. Questions addressed residents' involvement in and attitudes towards research, as well as their perceptions of the utility of research involvement during training. The residents were also asked about the support they received and potential areas to improve the attainment of this competency. Descriptive and correlative statistics were used to analyze the responses.

RESULTS

There was a 100% overall response rate to the questionnaire. This study revealed that Canadian urology residents have a high rate of participation in scholarly work, with the vast majority (94%) publishing at least one manuscript with a mean of four papers. Despite this, there appeared to be significant variation in the respondent's experiences, including protected time for research. Furthermore, many residents appeared unconvinced of the importance of research involvement, with only 51% agreement that participation was important to their overall training. As well, a significant number of residents reported largely external, rather than internal, motivations for research participation, such as attaining a preferred fellowship (66% agreement). While the majority of respondents felt (66% agreement) that the scholar role was important in residency training, it would appear that significant barriers, including time and mentorship, limited the effectiveness of research participation to gain those competencies.

CONCLUSIONS

The results of this self-report survey outline the significant differences in attitudes and experience towards mandatory research as a component of scholarship in Canadian urology training programs. As postgraduate medical education evolves, particularly with the uptake of competency-based medical education, programs and residents will need to address the motives and barriers to better foster academic pursuits during urology training.

Exploring intentions of physician-scientist trainees: factors influencing MD and MD/PhD interest in research careers

BACKGROUND

Prior studies have described the career paths of physician-scientist candidates after graduation, but the factors that influence career choices at the candidate stage remain unclear. Additionally, previous work has focused on MD/PhDs, despite many physician-scientists being MDs. This study sought to identify career sector intentions, important factors in career selection, and experienced and predicted obstacles to career success that influence the career choices of MD candidates, MD candidates with research-intense career intentions (MD-RI), and MD/PhD candidates.

METHODS

A 70-question survey was administered to students at 5 academic medical centers with Medical Scientist Training Programs (MSTPs) and Clinical and Translational Science Awards (CTSA) from the NIH. Data were analyzed using bivariate or multivariate analyses.

RESULTS

More MD/PhD and MD-RI candidates anticipated or had experienced obstacles related to balancing academic and family responsibilities and to balancing clinical, research, and education responsibilities, whereas more MD candidates indicated experienced and predicted obstacles related to loan repayment. MD/PhD candidates expressed higher interest in basic and translational research compared to MD-RI candidates, who indicated more interest in clinical research. Overall, MD-RI candidates displayed a profile distinct from both MD/PhD and MD candidates.

CONCLUSIONS

MD/PhD and MD-RI candidates experience obstacles that influence their intentions to pursue academic medical careers from the earliest training stage, obstacles which differ from those of their MD peers. The differences between the aspirations of and challenges facing MD, MD-RI and MD/PhD candidates present opportunities for training programs to target curricula and support services to ensure the career development of successful physician-scientists.

Professional identity in clinician-scientists: brokers between care and science

CONTEXT

Despite increasing numbers of publications, science often fails to significantly improve patient care. Clinician-scientists, professionals who combine care and research activities, play an important role in helping to solve this problem. However, despite the ascribed advantages of connecting scientific knowledge and inquiry with health care, clinician-scientists are scarce, especially amongst non-physicians. The education of clinician-scientists can be complex because they must form professional identities at the intersection of care and research. The successful education of clinician-scientists requires insight into how these professionals view their professional identity and how they combine distinct practices.

OBJECTIVES

This study sought to investigate how recently trained nurse- and physiotherapist-scientists perceive their professional identities and experience the crossing of boundaries between care and research.

METHODS

Semi-structured interviews were conducted with 14 nurse- and physiotherapist-scientists at 1 year after they had completed MSc research training. Interviews were thematically analysed using insights from the theoretical frameworks of dialogical self theory and boundary crossing.

RESULTS

After research training, the initial professional identity, of clinician, remained important for novice clinician-scientists, whereas the scientist identity was experienced as additional and complementary. A meta-identity as broker, referred to as a 'bridge builder', seemed to mediate competing demands or tensions between the two positions. Obtaining and maintaining a dual work position were experienced as logistically demanding; nevertheless, it was considered beneficial for crossing the boundaries between care and research because it led to reflection on the health profession, knowledge integration, inquiry and innovation in care, improved data collection, and research with a focus on clinical applicability.

CONCLUSIONS

Novice clinician-scientists experience dual professional identities as care providers and scientists. The meta-position of being a broker who connects care and research is seen as core to the unique clinician-scientist identity. To develop this role, identity formation and boundary-crossing competencies merit explicit attention within clinician-scientist programmes.

Role of non-government organizations in engaging medical students in research

The continued decline in medical trainees entering the workforce as clinician-scientists has elevated the need to engage medical students in research. While past studies have shown early exposure to generate interest among medical students for research and academic careers, financial constraints have limited the number of such formal research training programs. In light of recent government budget cuts to support research training for medical students, non-government organizations (NGOs) may play a progressively larger role in supporting the development of clinician-scientists. Since 2005, the Mach-Gaensslen Foundation has sponsored 621 Canadian medical student research projects, which represents the largest longitudinal data set of Canadian medical students engaged in research. We present the results of the pre- and post-research studentship questionnaires, program evaluation survey and the 5-year and 10-year follow-up questionnaires of past recipients. This paper provides insight into the role of NGOs as stakeholders in the training of clinician-scientists and evaluates the impact of such programs on the attitudes and career trajectory of medical students. While the problem of too few physicians entering academic and research-oriented careers continues to grow, alternative-funding strategies from NGOs may prove to be an effective approach in developing and maintaining medical student interest in research.

Professional Identity Formation and the Clinician-Scientist: A Paradigm for a Clinical Career Combining Two Distinct Disciplines

The clinician-scientist role is critical to the future of health care, and in 2010, the Carnegie Report on Educating Physicians focused attention on the professional identity of practicing clinicians. Although limited in number, published studies on the topic suggest that professional identity is likely a critical factor that determines career sustainability. In contrast to clinicians with a singular focus on clinical practice, clinician-scientists combine two major disciplines, clinical medicine and scientific research, to bridge discovery and clinical care. Despite its importance to advancing medical practice, the clinician-scientist career faced a variety of threats, which have been identified recently by the 2014 National Institutes of Health Physician Scientist Workforce. Yet, professional identity development in this career pathway is poorly understood. This Perspective focuses on the challenges to the clinician-scientist's professional identity and its development. First, the authors identify the particular challenges that arise from the different cultures of clinical care and science and the implications for clinician-scientist professional identity formation. Next, the authors synthesize insights about professional identity development within a dual-discipline career and apply their analysis to a discussion about the implications for clinician-scientist identity formation. Although not purposely developed to address identity formation, the authors highlight those elements within clinician-scientist training and career development programs that may implicitly support identity development. Finally, the authors highlight a need to identify empirically the elements that compose and determine clinician-scientist professional identity and the processes that shape its formation and sustainability.

Impact of Integrated Vascular Residencies on Academic Productivity within Vascular Surgery Divisions

BACKGROUND

Changing training paradigms in vascular surgery have been introduced to reduce overall training time. Herein, we sought to examine how shortened training for vascular surgeons may have influenced overall divisional academic productivity.

METHODS

Faculty from the top 55 surgery departments were identified according to National Institutes of Health (NIH) funding. Academic metrics of 315 vascular surgery, 1,132 general surgery, and 2,403 other surgical specialties faculty were examined using institutional Web sites, Scopus, and NIH Research Portfolio Online Reporting Tools from September 1, 2014, to January 31, 2015. Individual-level and aggregate numbers of publications, citations, and NIH funding were determined.

RESULTS

The mean size of the vascular divisions was 5 faculty. There was no correlation between department size and academic productivity of individual faculty members (R² = 0.68, P = 0.2). Overall percentage of vascular surgery faculty with current or former NIH funding was 20%, of which 10.8% had major NIH grants (R01/U01/P01). Vascular surgery faculty associated with integrated vascular training programs demonstrated significantly greater academic productivity. Publications and citations were higher for vascular surgery faculty from institutions with both integrated and traditional training programs (48 of 1,051) compared to those from programs with integrated training alone (37 of 485) or traditional fellowships alone (26 of 439; P < 0.05).

CONCLUSIONS

In this retrospective examination, academic productivity was improved within vascular surgery divisions with integrated training programs or both program types. These data suggest that the earlier specialization of integrated residencies in addition to increasing dedicated vascular training time may actually help promote research within the field of vascular surgery.