History and Outcomes of Fifty Years of Physician-Scientist Training in Medical Scientist Training Programs

Abstract

Physician-scientists are needed to continue the great pace of recent biomedical research and translate scientific findings to clinical applications. MD-PhD programs represent one approach to train physician-scientists. MD-PhD training started in the 1950s and expanded greatly with the development of the Medical Scientist Training Program (MSTP), launched in 1964 by the National Institute of General Medical Sciences (NIGMS) at the National Institutes of Health. MD-PhD training has been influenced by substantial changes in medical education, science, and clinical fields since its inception. In 2014, NIGMS held a 50th Anniversary MSTP Symposium to highlight the program and assess its outcomes. As of 2016, there were over 90 active MD-PhD programs in the United States, of which 45 were MSTP-supported, with a total of 988 trainee slots. Over 10,000 students have received MSTP support since 1964. The authors present data for the demographic characteristics and outcomes for 9,683 MSTP trainees over the period 1975–2014. The integration of MD and PhD training has allowed trainees to develop a rigorous foundation in research in concert with clinical training. MSTP graduates have had relative success in obtaining research grants, and some have become prominent leaders in many biomedical research fields. Many challenges remain, however, including the need to maintain rigorous scientific components in evolving medical curricula, to enhance research-oriented residency and fellowship opportunities in a widening scope of fields targeted by MSTP graduates, to achieve greater racial diversity and gender balance in the physician-scientist workforce, and to sustain subsequent research activities of physician-scientists.

Physician-scientists, who have clinical understanding coupled with the scientific skills to conduct state-of-the art research, are needed for both disease mechanism research and bench-to-bedside translation. This has dictated the development of training pathways that provide rigorous scientific training in concert with clinical training. Some physician-scientists receive their major scientific training during residency or fellowship research periods after completion of medical school. MD-PhD dual degree training, which provides scientific training earlier in the training sequence, represents another approach. Since 1964, MD-PhD training has been facilitated by Medical Scientist Training Program (MSTP) support from the National Institute of General Medical Sciences (NIGMS) of the National Institutes of Health (NIH). A meeting was held on July 17, 2014, at the NIH campus in Bethesda, MD, to recognize the 50th anniversary of the MSTP. Here, we review the development and evolution of MD-PhD training programs over the past 50 years and assesses the outcomes of MD-PhD training.