A global view of the aspiring physician-scientist

National Institutes of Health Funding to Support Radiation Oncology Research: A Comparative Trend Analysis Over a Decade, 2011-2021

Purpose

Funding to support radiation oncology discovery and research is essential for advancement in therapeutic strategies to improve outcomes for patients with cancer. We aimed to comprehensively characterize trends in National Institutes of Health (NIH) funding that supports radiation oncology research over time to identify trends, successes, and areas for improvement.

Methods and Materials

We queried the NIH Research Portfolio Online Reporting Tools Expenditures and Results database to identify all awarded grants to support radiation oncology research conducted by principal investigators at academic centers, using 3 individual years as representative samples (2011, 2016, and 2021). Abstracts and keywords for resulting grants were manually searched to identify resulting awards topically related to the field of radiation oncology; principal investigators departmental affiliation was also used as a supplemental method serving as a sensitivity analysis to define radiation oncology-related research. Descriptive statistics were used to describe patterns in funding. χ2 testing was used to assess differences in proportions of categorical variables.

Results

Less than 0.5% of the total NIH budget and < 2% of the total National Cancer Institute budget supported radiation oncology research during the representative study years. There were no significant changes in this allocation pattern over time. A small cohort of institutions held a relatively large proportion of NIH-supported radiation oncology grant funding. Individuals holding PhDs alone received the majority of funding (62%), whereas those with dual-degrees (MD/PhD) held 21% of funding, and those with MD alone were awarded 17% of funding. There was a trend toward an increased proportion of grants awarded to MD/PhDs over time (24% vs 15% in 2021 and 2011, respectively, P = .075).

Conclusions

Despite radiation therapy's essential role in multidisciplinary cancer care, NIH, and National Cancer Institute funding to support radiation oncology research has remained disproportionally low over the last decade. These data may be useful to inform future policy aimed at promoting research advancement in radiation oncology both at the micro (individual) as well as macro (institutional and national) level.

Physician-Scientist Training System and Development Strategies in Korea

Physician-scientists play a pivotal role in bridging clinical practice and biomedical research, advancing medical science, and tackling complex healthcare challenges. In South Korea, the declining number of medical doctors engaging in basic medical sciences has prompted the implementation of various training initiatives since the 2000s. Notable initiatives, such as the Integrated Physician-Scientist Training Program (2019) and the Global Physician-Scientist Training Program (2024), aim to cultivate multidisciplinary physician-scientists capable of addressing unmet medical needs. This study offers a comprehensive overview of the current training systems, funding mechanisms, and strategic approaches for physician-scientists in South Korea, compares them with international best practices, and proposes actionable policy recommendations to enhance their effectiveness and long-term sustainability.

Prioritizing mental health support for physician-scientist trainees

Tuazon et al. highlight the mental health challenges facing physician-scientist trainees, who have a dual commitment to advancing clinical care and undertaking research. The authors outline the critical gaps in mental health support structures available to this unique trainee population and provide recommendations to redress the concerns discussed.

Paving the physician-scientist career path: from grassroots gathering to national forum

The Alliance for Academic Internal Medicine (AAIM) first convened a workshop in 2015 that brought a small group of internal medicine program directors together who recognized the growing success of early-phase physician-scientist training programs but the unclear path afterward for these trainees. The meeting subsequently evolved into what is now the annual American Society for Clinical Investigation/AAIM/Burroughs Wellcome Fund (ASCI/AAIM/BWF) Physician-Scientist Pathways Workshop, which continues to bring stakeholders together to discuss the obstacles to success that physician-scientists face at all stages of their careers. This perspective presents the history and goals of the workshop, with an emphasis on the most recent meeting in 2024, and looks ahead to the work that still needs to be done to ensure a robust physician-scientist workforce.

Recent advances in basic research on prostate cancer: Where we are heading?

In the over 80 years since androgens were found to play a pivotal role in prostate cancer (PCa) progression, androgen deprivation therapy (ADT) has been a cornerstone in treating advanced PCa. Castration-resistant PCa persists, however, with some of these tumors evolving to androgen receptor (AR)-independent forms like neuroendocrine PCa. The development of novel diagnostic and therapeutic approaches to PCa is therefore crucial. This review provides an overview of recent basic research in PCa, focusing on two main areas: PCa cells and their tumor microenvironments. The first section describes current knowledge on the intricate mechanisms of AR signaling pathways, emphasizing the roles of coactivators and chromatin state alterations in gene regulation. Genomic analyses have revealed recurrent mutations and copy number alterations critical for precision medicine. Liquid biopsy has become a promising tool for real-time tumor monitoring, identifying genetic alterations in circulating-tumor DNA or extracellular vesicles. The second section describes the tumor microenvironment of PCa, highlighting its immunosuppressive landscape and the potential of combining ADT with immunotherapy. Advanced techniques, including single-cell RNA sequencing and spatial transcriptomics offer insights into cellular heterogeneity and interactions within the tumor microenvironment, paving the way for novel therapeutic strategies. Integration of these diverse research areas will provide a comprehensive understanding of the current state and future directions of PCa research, underscoring the importance of personalized medicine and the dynamic nature of cancer treatment strategies.

A transdisciplinary dual degree curriculum yields novel and successful learning outcomes: early lessons from training physicianeers

The evolving needs in healthcare education and delivery have led to diverse MD-based dual degree programs offering trainees broader experiences and credential-based credibility after graduation. Medical schools typically implement multidisciplinary or interdisciplinary dual degree training with designs that separate the contributing disciplines chronologically and experientially. As a result, these designs fail to maximize the cohesive learning environment and outcomes possible with a transdisciplinary dual degree design, which integrates the contributing disciplines chronologically, experientially, and conceptually. Though rare, transdisciplinary dual degrees promise transformative educational outcomes and discipline convergence by dissolving traditional discipline boundaries and fostering a new learning environment and professional identity. Therefore, we hypothesize that a transdisciplinary dual degree curriculum yields novel-and potentially better-learning outcomes. ENMED, a transdisciplinary dual degree program collaboratively developed, sponsored, and implemented by Texas A&M University and Houston Methodist Hospital, is testing this hypothesis by training "physicianeers." This new type of healthcare professional trains simultaneously for the MD and Master of Engineering degrees, thereby integrating medical and engineering expertise to advance health system innovations. Supporting the hypothesis, ENMED's early experiences suggest its transdisciplinary dual-degree model leads physicianeer trainees to novel perspectives with the potential to transform healthcare systemically.

2024 Physician-Scientist Trainee Diversity Summit conference proceedings

The Physician-Scientist Trainee Diversity Summit, hosted by the American Physician Scientists Association and the Burroughs Wellcome Fund, was conceived in 2019 with the mission of developing strategic plans to diversify the physician-scientist community using human-centered design thinking. In June 2024, the second iteration of this conference was held in Raleigh, North Carolina, and brought together a network of scientific and medical organizations to discuss issues of justice, equity, diversity, and inclusion facing physician-scientist trainees. This article summarizes the progress made from the first meeting, the proceedings of the 2024 Summit, and a thematic analysis of the recent meeting, offering tangible solutions to the physician-scientist community for supporting diversity and accessibility.

Medicine Meets Science: The Imperative of Scientific Research and Publishing for Physician-Scientists

Physician-scientists serve as conduits between clinical practice and scientific research, leveraging their unique expertise to improve patient care and drive medical innovation. This article highlights the indispensable role of research and publishing in promoting evidence-based practices, facilitating professional growth, and shaping public health policy. Drawing on historical and contemporary examples, I examine the challenges faced by physician-scientists, such as ethical dilemmas and declining engagement in research, particularly in resource-constrained settings. I suggest pragmatic strategies to overcome these barriers, emphasizing the need for systemic support, ethical integrity, and the equitable dissemination of advancements. This piece aims to inspire a new generation of physician-scientists to engage deeply with both clinical and research domains, thus advancing global health equity and resilience.

Effectiveness of simulation-based clinical research curriculum for undergraduate medical students - a pre-post intervention study with external control

BACKGROUND

Simulation is widely utilized in medical education. Exploring the effectiveness of high-fidelity simulation of clinical research within medical education may inform its integration into clinical research training curricula, finally cultivating physician-scientist development.

METHODS

Standard teaching scripts for both clinical trial and cross-sectional study simulation were designed. We recruited undergraduates majoring in clinical medicine at 3th grade into a pre-post intervention study. Additionally, a cross-sectional survey randomly selected medical undergraduates at 4th or 5th grade, medical students in master and doctor degree as external controls. Self-assessment scores of knowledge and practice were collected using a 5-point Likert scale. Changes in scores were tested by Wilcoxon signed-rank test and group comparisons were conducted by Dunn's tests with multiple corrections. Multivariable quantile regressions were used to explore factors influencing the changes from baseline.

RESULTS

Seventy-eight undergraduates involved the clinical trial simulation and reported improvement of 1.60 (95% CI, 1.48, 1.80, P < 0.001) in knowledge and 1.82 (95% CI, 1.64, 2.00, P < 0.001) in practice score. 83 undergraduates involved in the observational study simulation and reported improvement of 0.96 (95% CI, 0.79, 1.18, P < 0.001) in knowledge and 1.00 (95% CI, 0.79, 1.21, P < 0.001) in practice. All post-intervention scores were significantly higher than those of the three external control groups, P < 0.001. Higher agreement on the importance of clinical research were correlated with greater improvements in scores. Undergraduates in pre-post study showed high confidence in doing a future clinical research.

CONCLUSION

Our study provides evidence supporting the integration of simulation into clinical research curriculum for medical students. The importance of clinical research can be emphasized during training to enhance learning effect.

Emergency medicine residency pathways for MD/PhD trainees: A national cross-sectional study of physician-scientist training programs

Background

Combined clinical and research training is common in residency programs outside emergency medicine (EM), and these pathways are particularly valuable for combined MD/PhD graduates planning to pursue a career as a physician-scientist. However, EM departments may not know what resources to provide these trainees during residency to create research-focused, productive, future faculty, and trainees may not know which programs support their goal of becoming a physician-scientist in EM. The objective of this study was to describe research training and resources available to MD/PhD graduates in EM residency training with a focus on dedicated research pathways.

Methods

This study was a cross-sectional inventory conducted through an electronic survey of EM residency program directors. We sought to identify dedicated MD/PhD research training pathways, with a focus on both resources and training priorities. Descriptive statistics were used to summarize survey responses.

Results

We collected 192 survey responses (69.6% response rate). Among respondents, 41 programs (21.4%) offered a research pathway/track, 52 (27.4%) offered a research fellowship, 22 (11.5%) offered both a residency research pathway/track and a research fellowship, and two (1.0%) offered a dedicated EM physician-scientist training pathway. Most programs considered research a priority and were enthusiastic about interviewing applicants planning a research career, but recruitment of physician-scientist applicants was not generally prioritized.

Conclusions

Some EM residency programs offer combined clinical and mentored research training for prospective physician-scientists, and nearly all residency programs considered research important. Future work will focus on improving the EM physician-scientist pipeline by optimizing pathways available to trainees during residency and fellowship.

Early Initiative of Structured Mentoring and Research for Social Disadvantage Trainees to Increase Diversity and Inclusion among Clinician Scientists

Background

There is a significant lag in integrating ethnically diverse healthcare trainees as clinician scientists. Although this gap is acknowledged, it is mostly focused physician scientists with a marked lag in dental scientists and the other healthcare fields such as the physician assistant program. We report on the outcome of three cohorts of underserved and economically disadvantaged trainees from a National Institute of Health Heart and Lung Blood Institute R25 summer training program with participants from four Rutgers Health Science schools.

Objective

The goal was to support inclusivity within clinician scientist workforce through career development and education.

Methods

We tested the hypothesis that early formal training with structured mentoring, research, career development, and didactic lectures will inspire trainees towards careers as clinician scientists. Trainees learned from the integration of research within the four health profession schools. We used a survey to assess how mentorship, research and career/educational development influence trainees' attitude for careers as clinician scientists. Career development included science communication, mentoring, data reproducibility, authorship, ethics in research, and models of healthcare institutional leadership.

Results

>80% of the trainees continued their engagement in research with peer-reviewed publications, with confidence to engage in scientific discussion. Trainees developed a sense of belonging and a psychological safety net as they integrate with other groups of academic fields with confidence. Among 29 contacts, 87% responded. Less than 10% of incoming trainees indicated research in their career plans, which changed to >90% after one summer.

Conclusions

Overall, this training program could serve as a `blueprint' for other programs to enhance careers in research, and to narrow the diversity gap among clinician scientists. Diversity among clinician scientists will enhance healthcare and disparities, and scientific innovation. Success would narrow the diversity gap among clinician scientists.

Making the match and breaking it: values, perceptions, and obstacles of trainees applying into physician-scientist training programs

BACKGROUND

Replenishing the physician-scientist workforce constitutes a central mission of medical education, but the loss of qualified trainees to non-academic positions remains an ongoing threat. Among the barriers facing physician-scientists today is the game-like model of U.S. medical residency matching through the National Research Matching Program (NRPM), which applies several assumptions regarding the comparability of applicant qualifications, cohort size, and the institutional breadth of applicants' training needs.

METHODS

The current report therefore summarizes the survey-based views and experiences of physician-scientist trainees obtained following the 2021-2022 application cycle for research-oriented residency programs, or physician-scientist training programs (PSTPs). From among this small cohort of applicants, we obtained survey-based feedback of 27 PSTP applicants across 17 U.S. medical universities, among whom 85% (23/27) matched into a PSTP.

RESULTS

Among these PSTP applicants, 25/27 (93%) recognized "scientific community" as the most important feature of a postgraduate training program, with applicants identifying as female placing a higher value on the program's infrastructure of personal and/or family support. Most (18/27) respondents found "waiting for interviews" as the most stressful phase of their application cycle, and roughly half of all respondents encountered at least one NRMP policy violation through post-interview communication. Specifically, 93% (25/27) respondents were contacted by at least one PSTP following interviews, and 1/3 of them admitted to feeling pressured into sharing their ranking preferences.

CONCLUSION

We highlight many previously unrecognized priorities among applicants to PSTPs, which include fostering community among its trainees and reinforcing structured mentoring. We uncover an inconsistency among PSTPs regarding the post-interview process, which represents an opportunity to better support applicants seeking to gauge programs according to their clinical, scientific, and academic interests as physician-scientists, while still adhering to NRMP policies.

Structural insights into the career path between pre- and postgraduate physician-scientist training programs

The growing complexities of clinical medicine and biomedical research have clouded the career path for physician-scientists. In this perspective piece, we address one of the most opaque career stage transitions along the physician-scientist career path, the transition from medical school to research-focused internal medicine residency programs, or physician-scientist training programs (PSTPs). We present the perspectives of medical scientist training program (MSTP) and PSTP directors on critical features of PSTPs that can help trainees proactively align their clinical and scientific training for successful career development. We aim to provide both trainees and MSTP directors with a conceptual framework to better understand and navigate PSTPs. We also offer interview-specific questions to help trainees gather data and make informed decisions in choosing a residency program that best supports their career.

Earlier First Publication Is Associated with More Future Publication

Participation in clinical research has served clinicians to develop academic careers, as well as to deepen clinical insights, implement evidence-based medicine practices, and even inspire new clinical questions. Early engagement in academic pursuits may better prepare clinicians to maintain long-term research productivity, rather than starting later in their careers.We included medical doctors who graduated from a medical university and retrospectively followed them for 10 years after graduation. The impact of at least one publication within the first 5 years on the achievement of ≥ 5 publications within 10 years was evaluated.A total of 79 medical doctors, including 60 (76%) men, were included. During the first 5 years, 21 (27%) published at least one paper. Overall, 25 (32%) achieved the primary outcome. At least one publication during the first 5 years was an independent predictor of the primary outcome (odds ratio 30.4, 95% confidence interval 2.68-251, P = 0.002). Medical doctors with at least one publication within the first 5 years had significantly higher cumulative 10-year publications compared to no publications within the first 5 years (9 [5, 13] versus 0 [0, 3], P < 0.001).In this retrospective study, we demonstrated that an early involvement in research defined by academic output was associated with higher odds of multiple publications later in a career. Prospective studies to validate our findings by involving young medical doctors in academic pursuits are needed to understand the longitudinal effects of early career academic productivity.

What are the chances? Clinician scientist` career pathways in Germany

BACKGROUND

Germany faces a lack of clinician scientists. This problem is widely acknowledged, not just in Germany, as clinician scientists are crucial for medical translation and innovation: trained in medical practice and research they are capable of translating scientific problems into clinical application and vice versa, clinical problems into research. The implementation of nationwide clinician scientist programs (CSPs) in Germany is supposed to solve the lack of trained clinician scientists and, as consequence, to improve the translational relationship between biomedical research and clinical practice. Against the backdrop of an increasing number of CSPs, our study provides early insights into their effectiveness with a focus on what it means to become a clinician scientist and to establish a subsequent career path as a clinician scientist in Germany.

METHODS

During a research project that was conducted from 2020 to 2023 and funded by the German Federal Ministry of Education and Research, we studied thirteen CSPs. We developed a qualitative questionnaire and interviewed 36 clinician scientists in training, their program supervisors, as well as policy stakeholders. The goal of the interviews was to identify the key obstacles in establishing a career path for clinician scientists in Germany.

RESULTS

We found three types of challenges for establishing and ensuring long term career paths for clinician scientists: First, local working conditions need to allow for clinician scientists to create and perform tasks that combine research, teaching, patient care and translation synergistically. Protection from the urgency of patient care and from metrics-based performance measures both in the clinic and in research seem key here. Second, a stable career path requires new target positions besides clinic management and senior residency. Third, there is a need for cultural change within university medicine that recognizes and rewards new translation-focused practices.

CONCLUSION

We find that CSPs improve working conditions for the duration of the program and provide protected time for doing research. After the programs, however, the career paths remain unstable, mainly due to a lack of target positions for clinician scientists. CSPs support the initial development of the clinician scientist' role, but not in a sustainable way, because the separation of research and patient care is stabilized on an institutional and systemic level. The tasks clinician scientists perform in research remain separate from patient care and teaching, thus, limiting their translational potential. In order to remain a clinician scientist within this differentiated system of university medicine, clinician scientists have to do a significant amount of extra work.

Lessons From an MD PhD - From SLC13A5 to Neurology

The journey towards becoming a physician scientist is a long, arduous, and uncertain journey. Few medical students pursue a career as a physician scientist. Even those that do, the path towards maintaining a robust research career and clinical training can be difficult given the personal and social pressures to focus solely on research or clinical work. Despite the long history of science and medicine, there is question concerning the role that physician scientist in modern medicine. As a recent physician scientist graduate, physician scientists are greatly needed in the medical profession. The ability to overlap science, medicine, and the humanities together is an essential part of the producing a well-rounded and effective physician for a rapidly changing profession and world. Through my journey as a physician scientist in training, the lessons I've learned through my training in both the basic science and clinical portions can be helpful for medical students traversing both sides of the divide.

Optimizing team science in an academic medical center: A qualitative examination of investigator perspectives

Introduction

Optimizing the effectiveness of a team-based approach to unite multiple disciplines in advancing specific translational areas of research is foundational to improving clinical practice. The current study was undertaken to examine investigators' experiences of participation in transdisciplinary team science initiatives, with a focus on challenges and recommendations for improving effectiveness.

Methods

Qualitative interviews were conducted with investigators from twelve multidisciplinary teams awarded pilot research funding by the University of Kentucky College of Medicine to better understand the barriers and facilitators to effective team science within an academic medical center. An experienced qualitative researcher facilitated one-on-one interviews, which lasted about one hour. Structured consensus coding and thematic analysis were conducted.

Results

The sample was balanced by gender, career stage (five were assistant professor at the time of the award, seven were senior faculty), and training (six were PhDs; six were MD physicians). Key themes at the team-level centered on the tension between clinical commitments and research pursuits and the limitations for effective team functioning. Access to tangible support from home departments and key university centers was identified as a critical organizational facilitator of successful project completion. Organizational barriers centered on operationalizing protected time for physicians, gaps in effective mentoring, and limitations in operational support.

Conclusions

Prioritizing tailored mentoring and career development support for early career faculty, and particularly physician faculty, emerged as a key recommendation for improving team science in academic medical centers. The findings contribute to establishing best practices and policies for team science in academic medical centers.

LEARNING TO PIVOT: DEVELOPING TALENT AND A CHAMPIONSHIP TEAM

Developing the future leaders of biomedical science is fundamentally the most important role that we play in academic medicine. Similar to the path to elite championship athletics, the path begins early: engaging young minds to find excitement in science, enlightening medical students on the importance of curiosity, challenging faculty to achieve milestones and mature as leaders. Coaching strategies are critical and are different at each developmental stage. It may seem that it is becoming harder to entice young talent to pursue a career in biomedical research, or that the perpetually leaky pipeline is corroding to the point of hemorrhage. This perspective will explore the factors contributing to this loss, with flow further compromised by low input volume and high demand, and survey the coaching strategies that inspire the drive to pursue biomedical inquiry and the range of skills that must be developed to enable our workforce to thrive.