The Scholarly Project Initiative: introducing scholarship in medicine through a longitudinal, mentored curricular program

The Impact of Scholarly Concentration Programs on Graduates' Career Choices and Interest in the Care of Older Patients

BACKGROUND

More geriatricians are needed to care for the aging population. Geriatric scholarly concentration programs (GSCPs) may promote medical students' interest in this underserved field or careers working with older adults. Additionally, graduates of GSCPs may be more comfortable and competent in providing care for older adults. Surveys were administered to graduates of GSCPs to determine the role of these programs in shaping medical students' careers and views about caring for older adults.  Methods: The purpose of this study is to understand the impact of GSCPs on medical graduates' career choices and self-perceived skill and comfort in caring for older adults. A Qualtrics survey (Qualtrics International Inc., Seattle, Washington, United States) was developed and distributed to 83 graduates of four GSCPs in the United States. Data were analyzed using a significance level of p>0.05 for all tests. Descriptive statistics were calculated to summarize the data. Wilcoxon signed-rank tests were used to test for significant differences in interest in pursuing a career in geriatrics or working with older adults. Qualitative responses were coded and analyzed for themes.  Results: A total of 34 out of 83 surveyed graduates of GSCPs indicated a higher interest in geriatrics as a career as well as increased comfort and self-perceived skill in caring for older adults after completing the GSCP. The components of the GSCP that most strongly improved the participants' ability to care for older adults included the curriculum (n=31, 91%) and mentoring (n=28, 82%). An overwhelming majority of survey participants felt GSCPs should be offered as part of medical school programming (n=33, 97%).  Conclusion: This study suggests that GSCPs increase interest and competence in caring for older adults and increase interest in a career in geriatrics. GSCPs should be implemented across medical schools.

Scoping Review: Research Training During Medical School

Fostering skills in research is important for medical schools. This scoping review examined undergraduate curricular structures devoted to research training and their outcomes. For the sixty papers meeting inclusion criteria, descriptive statistics and a thematic analysis were conducted. Forty (67%) articles described US programs, with 30 (50%) being mandatory. Timing of research training was variable across included studies with the majority (58%) describing embedded longitudinal curricula. Reported benefits included enhanced knowledge, improved research and writing skills, clarity around career plans, and mentoring relationships. There are many curricular structures for undergraduate research training, but no high-quality evidence to support particular designs.

The impact of medical student research as a discussion topic during the residency interview process

BACKGROUND

Students with a greater number of research experiences are more successful in the National Residency Match Program (NRMP.) As a result, approximately two-thirds of allopathic medical schools have implemented a scholarly research project (SP) as a part of their curriculum. While inclusion of an SP in the medical school curriculum increases research productivity, literature to date has not investigated the frequency with which it is a discussion topic during residency interviews.

METHODS

One hundred twenty-three students from the graduating class of 2019 and 2020 at the University of Arizona College of Medicine - Phoenix (UACOMP) completed a 17-question survey examining the student's SP and whether they completed additional research, with an overall response rate of 82.6%. Survey participants were asked to quantify how many residency interviewers asked about their SP or additional research during the interview process.

RESULTS

Twenty-seven percent of interviewers asked students about their SP and 41% of interviewers asked students about additional non-SP research. 40% of interviewers asked about research overall to include SP and/or non-SP research. A greater percentage of interviewers (50%) asked students about their SP if they had undertaken additional research compared to interviewers of students who did not undertake additional research (29%, p = 0.0237). A greater percentage of interviewers at academic institutions (31%) asked students about their SP, compared with a smaller percentage of interviewers at predominantly non-academic programs (22%, p = 0.0054). There were no significant differences in the proportion of interviewers asking about the SP based on the type of specialty, competitiveness of specialty, relatedness project topic to specialty, and publication/presentation status of project.

CONCLUSION

Student research experiences may serve as a frequent discussion topic during the residency interview. Approximately one-quarter of interviewers ask about the SP regardless of specialty, research topic, and publication/presentation status of the project. Students with additional research experiences beyond their SP may experience a higher percentage of interviewers asking about their SP. Also, students applying to predominantly academic programs may experience a higher proportion of interview questions about research compared to peers interviewing at non-academic programs.

Impact of A Required, Longitudinal Scholarly Project in Medical School: A Content Analysis of Medical Students' Reflections

INTRODUCTION

Medical schools increasingly require students to complete scholarly projects. Scholarly project programs that are required and longitudinal require considerable resources to implement. It is necessary to understand medical students' perspectives on the impact of such programs. Students at the University of Pittsburgh School of Medicine participate in a required, longitudinal research program (LRP) throughout all years of medical school training. Authors studied students' perceptions of this program.

METHODS

Fourth-year medical students submit a written report in which they reflect on their experience with the LRP. Qualitative analysis of students' written reflections was performed on 120 reports submitted 2012-2017. Content analysis was performed using an inductive approach in which investigators coded information and searched for emerging themes.

RESULTS

Four themes were identified. First, students described engaging in many steps of the research process, with many participating in projects from conception to completion. Second, students reported the LRP provided opportunities for leadership and independence, and many found this to be meaningful. Third, students developed appreciation for the difficulty of the research process through challenges encountered and practiced problem solving. Fourth, students acquired skills useful across multiple career paths, including critical appraisal of scientific literature, teamwork, and communication.

DISCUSSION

Through participation in a required, longitudinal research program, medical students reported gaining valuable skills in leadership, problem solving, critical thinking, and communication. Students found that the longitudinal nature of the program enabled meaningful research experiences. These educational impacts may be worth the effort of implementing and maintaining longitudinal research experiences for medical students.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01319-6.

Determining Expected Research Skills of Medical Students on Graduation: a Systematic Review

BACKGROUND

Global interest in research skills in undergraduate medical education is growing. There is no consensus regarding expected research skills of medical students on graduation. We conducted a systematic review to determine the aims and intended learning outcomes (ILOs) of mandatory research components of undergraduate medical curricula incorporating the teaching, assessment, and evaluation methods of these programs.

METHODS

Using the PRISMA protocol, MEDLINE and ERIC databases were searched with keywords related to "medical student research programs" for relevant articles published up until February 2020. Thematic analysis was conducted according to student experience/reactions, mentoring/career development, and knowledge/skill development.

RESULTS

Of 4880 citations, 41 studies from 30 institutions met the inclusion criteria. Programs were project-based in 24 (80%) and coursework only-based in 6 (20%). Program aims/ILOs were stated in 24 programs (80%). Twenty-seven different aims/ILOs were identified: 19 focused on knowledge/skill development, 4 on experience/reactions, and 4 on mentoring/career development. Project-based programs aimed to provide an in-depth research experience, foster/increase research skills, and critically appraise scientific literature. Coursework-based programs aimed to foster/apply analytical skills for decision-making in healthcare and critically appraise scientific literature. Reporting of interventions was often incomplete, short term, and single institution. There was poor alignment between aims, teaching, assessment, and evaluation methods in most.

CONCLUSIONS

The diversity of teaching programs highlights challenges in defining core competencies in research skills for medical graduates. Incomplete reporting limits the evidence for effective research skills education; we recommend those designing and reporting educational interventions adopt recognized educational reporting criteria when describing their findings. Whether students learn by "doing", "proposing to do", or "critiquing", good curriculum design requires constructive alignment between teaching, assessment, and evaluation methods, aims, and outcomes. Peer-reviewed publications and presentations only evaluate one aspect of the student research experience.

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.

Geriatrics Scholarly Concentration Programs Among U.S. Medical Schools

OBJECTIVES

To identify and describe geriatric scholarly concentration programs (GSCPs) among U.S. medical schools.

DESIGN

Survey and interview.

SETTING

Allopathic and osteopathic medical schools in the United States.

PARTICIPANTS AND METHODS

We used a systematic internet search, forum postings, and word of mouth to identify all U.S. allopathic and osteopathic medical schools with existing GSCPs. GSCP directors completed an online survey. We conducted interviews with key faculty of two representative programs.

MEASUREMENTS

GSCP size, goals, duration of activity, requirements, funding sources, and student outcomes.

RESULTS

Nine GSCPs were identified, and eight responded to the survey. The number of current medical student participants ranged from 0 to 28, with a mean cohort size of 23. All programs included the following components: formal mentoring, clinical experiences in geriatric medicine beyond the standard medical school curriculum, and research. Half required students to complete an independent research project. GSCPs reported challenges, including low student interest, lack of availability of faculty mentors, and budget constraints; however, student satisfaction was high. Among three programs that reported on the residency matches of their graduates, half matched into a residency with a geriatric subspecialty training option.

CONCLUSIONS

Among U.S. medical schools, there are few GSCPs. The GSCP model may help compensate for limited exposure to geriatric competencies in the standard medical school curriculum for a subset of interested students and may increase interest in geriatrics subspecialty training.

Outcomes from an elective medical student Research Scholarly Concentration program

To examine how to increase research career outcomes among medical graduates, we analyzed the impact of the Research Scholarly Concentration at The George Washington University School of Medicine and Health Sciences. Residency placement, subsequent scholarship, and career outcomes were compared among 670 graduates who participated in the elective Clinical and Translational Research Scholarly Concentration or no Concentration between 2009 and 2018. We conducted a retrospective study of residency match (highly selective vs less selective), job type (academic vs non-academic), and postmedical school publications (any vs none). We compared the outcomes between Research Scholarly Concentration graduates and those with no Concentration, matched by graduation year (n=335). For Research Scholarly Concentration graduates, we examined the association between research outcomes and duration of research experience before medical school (n=232). Research Scholarly Concentration graduates were more likely to place in a highly selective residency (40.2% vs 21.6%, p<0.0001), 68% more likely to publish after medical school (OR=1.68, 95% CI 1.10 to 2.58), and almost four times as likely to have taken an academic health center job (OR=3.82, 95% CI 1.72 to 8.46) than graduates with no Concentration. Surprisingly, the length of research experience before medical school was not associated with these outcomes among Research Scholarly Concentration graduates. This suggests that a medical school Research Scholarly Concentration is effective in training physician researchers and should be available to both novices and research-experienced matriculants. These data suggest how other medical schools might plan Scholarly Concentration programs to improve research outcomes among medical graduates.

Scholarly Research Projects Benefit Medical Students' Research Productivity and Residency Choice: Outcomes From the University of Pittsburgh School of Medicine

PURPOSE

Many medical schools require scholarly research projects. However, outcomes data from these initiatives are scarce. The authors studied the impact of the Scholarly Research Project (SRP), a four-year longitudinal requirement for all students at the University of Pittsburgh School of Medicine (UPSOM), on research productivity and residency match.

METHOD

The authors conducted a longitudinal study of non-dual-degree UPSOM graduates in 2006 (n = 121, non-SRP participants) versus 2008 (n = 118), 2010 (n = 106), and 2012 (n = 132), all SRP participants. The authors used PubMed for publication data, National Resident Matching Program for residency match results, and Blue Ridge Institute for Medical Research for National Institutes of Health funding rank for residency-affiliated academic institutions.

RESULTS

Research productivity of students increased for those completing the SRP, measured as a greater proportion of students with publications (27.3% in 2006 vs. 45.8% in 2008, 55.7% in 2010, and 54.5% in 2012; P < .001) and first-authorship (9.9% in 2006 vs. 26.3% in 2008, 33.0% in 2010, and 35.6% in 2012; P < .001). Across years, there was a significantly greater proportion of students with peer-reviewed publications matched in higher-ranked residency programs (57.0% with publications in the top 10%, 52.7% in the top 10%-25%, 32.4% in the top 25%-50%, 41.2% in the bottom 50%, and 45.2% in unranked programs; P = .018).

CONCLUSIONS

Longitudinal research experiences for medical students may be one effective tool in fostering student publications and interest in extending training in a research-focused medical center.

A Strategic Plan for Increasing Scholarly Activity Among Medical Students, Residents, and Faculty

BACKGROUND

Scholarly activity among students, residents, and faculty provides the foundation for medical education. However, a decline in the number of physician-scientists has been acknowledged during the past few decades. As a result, institutions have attempted to increase research activity among students and residents through a variety of means. This study describes a replicative model for medical institutions to increase their research enterprises among medical students, residents, and faculty.

METHODS

Des Moines University College of Podiatric Medicine and Surgery (DMU-CPMS) developed a Strategic Research Plan (SRP) to increase scholarly activity in the college. The SRP outlined an innovative model to increase research activity, including creating a Director of Research position, modifying the existing curriculum toward an evidence-based focus, increasing extracurricular research opportunities, and fostering collaborative research efforts among students, residents, and faculty.

RESULTS

After SRP implementation, an increase in scholarly activity was observed. In the 6 years before implementing the SRP, DMU-CPMS published 11 manuscripts. In the 6 years after initiating the SRP, manuscript publications increased to 50. During this same period, podium presentations at scientific meetings increased from 6 to 40, and students listed as lead author increased from 0 to 16.

CONCLUSIONS

The SRP provides a replicative model for medical institutions seeking to increase their research enterprises through collaboration among students, residents, and faculty. To our knowledge, this is the first study to demonstrate a research plan aimed at increasing scholarly activity among a comprehensive scope of individuals in medical education.

Goals of medical students participating in scholarly concentration programmes

OBJECTIVES

Scholarly concentration (SC) programmes are increasingly common in medical school curricula, fostering student participation in mentored research. Endpoints including publication rates and impact on career path have been reported, but student goals have not been described. We describe how career plans and gender impact the importance of students' SC-related goals. Understanding student goals may enhance mentorship of professional development and self-directed learning skills.

METHODS

First-year students at two US medical schools were surveyed. Students reported intentions regarding career-long research and specialty interests. Using a 5-point scale, students assigned importance to 13 goals (eight skill-related goals, four accomplishment-related goals and mentorship), Composite scores for skills-related and accomplishment-related goals were used for analysis. Regression analyses, controlling for school, were used to determine whether intentions regarding career-long research, interest in highly competitive residency or gender were associated with increased importance of different goals.

RESULTS

We surveyed 288 first-year medical students and received 186 responses (64.6% response rate). Compared with their peers, students interested in career-long research placed more importance on both skill-related goals (beta coefficient, 1.87; 95% confidence interval [CI], 1.03-2.71; p < 0.001) and accomplishment-related goals (odds ratio [OR], 1.71; 95% CI, 1.09-2.69; p = 0.02). By contrast, compared with their peers, students interested in highly competitive specialties placed more importance only on accomplishment-related goals (OR, 2.18; 95% CI, 1.15-4.11; p = 0.02). Compared with men, women placed more importance on mentorship (OR, 2.47; 95% CI, 1.23-4.97; p = 0.01) and were less likely to be interested in highly competitive residencies (39.4% versus 54.9%, p = 0.04).

CONCLUSIONS

Gender and career plans are associated with importance of SC-related goals in the first year of medical school. This knowledge enables faculty to promote students' appreciation of important learning goals in the setting of student research, which may help students engage in self-directed learning across their medical education.

Factors associated with physicians' choice of a career in research: a retrospective report 15 years after medical school graduation

Relatively little is known regarding factors associated with the choice of a research career among practicing physicians, and most investigations of this issue have been conducted in the absence of a theoretical/conceptual model. Therefore we designed a survey to identify the determinants of decisions to pursue a biomedical research career based upon the Theory of Planned Behavior and the concept of stereotype threat. From October 2012 through January 2014 electronic surveys were sent to four consecutive Harvard Medical School graduating classes, 1996-1999. Respondents provided demographic information, indicated their current research involvement, and provided retrospective reports of their experiences and attitudes when they were making career choices as they completed medical school. Multivariable ordinal regression was used to identify factors independently associated with current research involvement. Completed questionnaires were received from 358 respondents (response rate 65 %). In unadjusted analyses, variables associated with more extensive research involvement included non-minority status, male gender, lower debt at graduation, strong attitudes toward research at time of graduation, and greater social pressures to pursue research (all P < .001). These associations remained significant in multivariable regression analysis (all P < 0.01). However, an interaction between sex and prior research publications was also detected, indicating that more extensive research involvement during medical school doubled the likelihood of a research career for women (OR 2.53, 95 % CI 1.00-6.40; P = 0.05). Most of the factors predicting research career choice involve factors that are potentially modifiable, suggesting that appropriately designed behavioral interventions may help to expand the size and diversity of the biomedical research community.

Scholarly Concentration Program Development: A Generalizable, Data-Driven Approach

PURPOSE

Scholarly concentration programs-also known as scholarly projects, pathways, tracks, or pursuits-are increasingly common in U.S. medical schools. However, systematic, data-driven program development methods have not been described.

METHOD

The authors examined scholarly concentration programs at U.S. medical schools that U.S. News & World Report ranked as top 25 for research or primary care (n = 43 institutions), coding concentrations and mission statements. Subsequently, the authors conducted a targeted needs assessment via a student-led, institution-wide survey, eliciting learners' preferences for 10 "Pathways" (i.e., concentrations) and 30 "Topics" (i.e., potential content) augmenting core curricula at their institution. Exploratory factor analysis (EFA) and a capacity optimization algorithm characterized best institutional options for learner-focused Pathway development.

RESULTS

The authors identified scholarly concentration programs at 32 of 43 medical schools (74%), comprising 199 distinct concentrations (mean concentrations per program: 6.2, mode: 5, range: 1-16). Thematic analysis identified 10 content domains; most common were "Global/Public Health" (30 institutions; 94%) and "Clinical/Translational Research" (26 institutions; 81%). The institutional needs assessment (n = 468 medical students; response rate 60% overall, 97% among first-year students) demonstrated myriad student preferences for Pathways and Topics. EFA of Topic preferences identified eight factors, systematically related to Pathway preferences, informing content development. Capacity modeling indicated that offering six Pathways could guarantee 95% of first-year students (162/171) their first- or second-choice Pathway.

CONCLUSIONS

This study demonstrates a generalizable, data-driven approach to scholarly concentration program development that reflects student preferences and institutional strengths, while optimizing program diversity within capacity constraints.

A flexible, preclinical, medical school curriculum increases student academic productivity and the desire to conduct future research

In 2006, small blocks of flexible curriculum time, termed selectives, were implemented in the Mayo Medical School preclinical curriculum. Selectives permitted students to pursue professional endeavors, such as research, service, and career exploration, in the preclinical years. The purpose of this study was to survey current and former Mayo medical students regarding the impact of selectives on their research interest and productivity. The authors surveyed 377 current and former Mayo Medical School students from the 2004 to 2014 graduating classes, 154 participants (41% response rate) responded to the survey. The classes were grouped into pre- and postselective groups for the comparison studies. Postselective students published significantly more (p = 0.003) and gave significantly more presentations (p = 0.0007) during medical school than preselective students. Thirty-four (72% of the postselective respondents) indicated that selectives had a strong or very strong impact on their current research interest. Respondents spent an average of 4.0 [3.0-5.0] weeks of Selective time on research, resulting in 1.8 [1.4-2.2] publications and 1.8 [1.4-2.2] presentations, which represented 52.5% [40.0-65.0%] and 47.3% [37.1-57.4%] of the students' total medical school publications and presentations, respectively. Flexible selective time during the preclinical years results in significantly more medical student academic productivity.

Why our patients (and we) need basic science research

In times of fiscal austerity, the tendency is to seek instant, inexpensive gratification. In the case of biomedical research, this means the shortest path to practical clinical implementation. But fueling the translational pipeline with discovery depends critically on allowing the biomedical research community to follow their science where it takes them. Fiscal constraints carry with them the risk of squelching creativity and forfeiting the power of serendipity to provide the substrate for the translational engine in the future.

An innovative portfolio of research training programs for medical students

Medical student education continues to evolve, with an increasing emphasis on evidence-based decision making in clinical settings. Many schools are introducing scholarly programs to their curriculum in order to foster the development of critical thinking and analytic skills, encourage self-directed learning, and develop more individualized learning experiences. In addition, participation in rigorous scholarly projects teaches students that clinical care and research should inform each other, with the goal of providing more benefit to patients and society. Physician-scientists, and physicians who have a better appreciation of science, have the potential to be leaders in the field who will deliver outstanding clinical care, contribute new knowledge, and educate their patients.

Initiating undergraduate medical students into communities of research practise: what do supervisors recommend?

BACKGROUND

Much has been written in the educational literature on the value of communities of practise in enhancing student learning. Here, we take the experience of senior undergraduate medical students involved in short-term research as a member of a team as a paradigm for learning in a community of practise. Based on feedback from experienced supervisors, we offer recommendations for initiating students into the research culture of their team. In so doing, we endeavour to create a bridge between theory and practise through disseminating advice on good supervisory practise, where the supervisor is perceived as an educator responsible for designing the research process to optimize student learning.

METHODS

Using the questionnaire design tool SurveyMonkey and comprehensive lists of contact details of staff who had supervised research projects at the University of Edinburgh during 1995-2008, current and previous supervisors were invited to recommend procedures which they had found successful in initiating students into the research culture of a team. Text responses were then coded in the form of derivative recommendations and categorized under general themes and sub-themes.

RESULTS

Using the chi-square tests of linear trend and association, evidence was found for a positive trend towards more experienced supervisors offering responses (χ2 = 16.833, p < 0.0005, n = 215) while there was a lack of evidence of bias in the gender distribution of respondents (χ2 = 0.482, p = 0.487, n = 203), respectively. A total of 126 codes were extracted from the text responses of 65 respondents. These codes were simplified to form a complete list of 52 recommendations, which were in turn categorized under seven derivative overarching themes, the most highly represented themes being Connecting the student with others and Cultivating self-efficacy in research competence.

CONCLUSIONS

Through the design of a coding frame for supervisor responses, a wealth of ideas has been captured to make communities of research practise effective mediums for undergraduate student learning. The majority of these recommendations are underpinned by educational theory and have the potential to take the learner beyond the stage of initiation to that of integration within their community of research practise.

The Emphasis Program: a scholarly concentrations program at Vanderbilt University School of Medicine

In 1999, a faculty committee at Vanderbilt University School of Medicine reviewed the mission and goals of the school and determined that graduates should receive initial preparation to develop scholarly careers in medicine. The authors describe the design of a scholarly projects course, the Emphasis Program, which is required of all students in the first two years of medical school. Each student undertakes a mentored project in one of nine areas of scholarship related to medicine. Curricular time is devoted to the program during the first two academic years, and students also spend eight weeks working on their projects in the intervening summer. The program includes a core didactic curriculum on topics common to all areas of scholarly work, such as biostatistics and study design. Implemented with the entering class of 2004, 467 students had completed the program as of May 2010, and only two students have been unable to complete projects in the allotted time. The majority of graduating seniors reported that they felt this was a valuable aspect of their medical education. Whereas the program offers a broad spectrum of scholarship opportunities, most students have selected projects in more traditional areas, such as laboratory-based research and patient-oriented research. The authors describe early successes in meeting program goals as well as some of the ongoing challenges of administering a required but individualized program of this nature.

Encouraging scholarship: medical school programs to promote student inquiry beyond the traditional medical curriculum

Many medical curricula now include programs that provide students with opportunities for scholarship beyond that provided by their traditional, core curricula. These scholarly concentration (SC) programs vary greatly in focus and structure, but they share the goal of producing physicians with improved analytic, creative, and critical-thinking skills. In this article, the authors explore models of both required and elective SC programs. They gathered information through a review of medical school Web sites and direct contact with representatives of individual programs. Additionally, they discuss in-depth the SC programs of the Warren Alpert Medical School of Brown University; the University of South Florida College of Medicine; the University of California, San Francisco; and Stanford University School of Medicine. The authors describe each program's focus, participation, duration, centralization, capstone requirement, faculty involvement, and areas of concentration. Established to address a variety of challenges in the U.S. medical education system, these four programs provide an array of possible models for schools that are considering the establishment of an SC program. Although data on the impact of SC programs are lacking, the authors believe that this type of program has the potential to significantly impact the education of medical students through scholarly, in-depth inquiry and longitudinal faculty mentorship.

Implementation of a longitudinal mentored scholarly project: an approach at two medical schools

An increasing number of medical schools have implemented or are considering implementing scholarly activity programs as part of their undergraduate medical curricula. The goal of these programs is to foster students' analytical skills, enhance their self-directed learning and their oral and written communication skills, and ultimately to train better physicians. In this article, the authors describe the approach to implementing scholarly activities at a school that requires this activity and at a school where it is elective. Both programs have dealt with significant challenges including orienting students to a complex activity that is fundamentally different than traditional medical school courses and clerkships, helping both students and their mentors understand how to "stay on track" and complete work, especially during the third and fourth years, and educating students and mentors about the responsible conduct of research, especially involving human participants. Both schools have found the implementation process to be evolutionary, requiring experience before faculty could significantly improve processes. A required scholarly activity has highlighted the need for information technology (IT) support, including Web-based document storage and student updates, as well as automatic e-mails alerting supervisory individuals to student activity. Directors of the elective program have found difficulty with both ensuring uniform outcomes across different areas of study and leadership changes in a process that has been largely student-driven. Both programs have found that teamwork, regular meetings, and close communication have helped with implementation. Schools considering the establishment of a scholarly activity should consider these factors when designing programs.

Introducing INSPIRE, a scholarly component in undergraduate medical education

Individualized learning is a fundamental tenet of the Carnegie Foundation's new recommendations for physician training. A primary goal of Mount Sinai School of Medicine's new curriculum is to train self-directed physicians who have mastered lifelong learning skills. The Individual Scholarly Project and Independent Research Experience (INSPIRE) was created to enable fourth-year students to conduct mentored, independent scholarly projects to develop critical thinking skills and intellectual independence. Four students were accepted into the 2008 12-week pilot. Two did clinical research, 1 conducted medical education research, and 1 continued a basic science project. INSPIRE featured weekly sessions in which students shared their progress, heard about the careers of physician-scientists, and participated in presentation skills workshops. Mentors gave feedback using a form based on the program goals. Anonymous evaluations showed that all participants believed their goals were successfully fulfilled, that the likelihood of including research in their careers increased, and that they felt more skilled at writing abstracts and presenting their work orally. Students agreed that INSPIRE was a valuable opportunity for acquiring in-depth knowledge on a topic and building research and presentation skills. Helping students shape an individualized scholarly experience may help to produce doctors who are self-directed, are personally fulfilled, are able to serve society with diverse expertise, and have the tools to become leaders in their fields.

Protecting an endangered species: training physicians to conduct clinical research

PURPOSE

The Program in Clinical Effectiveness (PCE) at Harvard School of Public Health is a postgraduate program emphasizing clinical research. The authors sought to evaluate the research careers of physician graduates and to determine correlates of National Institutes of Health (NIH) grant funding.

METHOD

In 2006, all 1,489 graduates from 1986-2005 were sent a 48-item survey that collected information on demographics, program experience, chosen career path, grant awards, and research pursued postprogram. Reported NIH grants were verified on the NIH Computer Retrieval of Information on Scientific Projects Web site. Cox proportional hazard regression was used to determine participant and program features associated with NIH grant funding.

RESULTS

Overall, 994 of the 1,365 located graduates (73%) responded to the survey. Graduates pursued research in the following areas: 437 respondents (44%) pursued clinical trials, 537 (54%) pursued epidemiology, and 408 (41%) pursued health services research. A total of 156 respondents (24%) were principal investigators on an NIH grant. Correlates of receiving NIH grant funding included age less than 40 years at time of program enrollment (hazard ratio [HR] 1.87, CI 1.03, 3.41), generalist status (HR 1.57, CI 1.14, 2.16), and publishing research begun as course projects (HR 1.65, CI 1.19, 2.31). Gender, academic status at enrollment, ethnicity, tuition sponsorship, and earning an advanced degree were not associated with receipt of NIH grant funding.

CONCLUSIONS

Physicians who enrolled in the PCE at an early age and generalist physicians were particularly successful in establishing careers as clinician-investigators. Programs such as the PCE can help to sustain the workforce of physician-investigators.

Personal journeys, professional paths: persistence in navigating the crossroads of a research career

Persistence in a research career can be readily understood within the trainee models that have emerged from undergraduate and graduate instruction. These models offer a common language for discussing training processes, serve as guides for assessing trainee needs, promise to render training programs that are more comprehensive and attentive than are current programs to the factors that contribute to academic and scientific persistence, and enable us to measure with greater precision, internal consistency, and generalizability the elements that logically belong in research career development programs.

Back to the basic sciences: an innovative approach to teaching senior medical students how best to integrate basic science and clinical medicine

Abraham Flexner persuaded the medical establishment of his time that teaching the sciences, from basic to clinical, should be a critical component of the medical student curriculum, thus giving rise to the "preclinical curriculum." However, students' retention of basic science material after the preclinical years is generally poor. The authors believe that revisiting the basic sciences in the fourth year can enhance understanding of clinical medicine and further students' understanding of how the two fields integrate. With this in mind, a return to the basic sciences during the fourth year of medical school may be highly beneficial. The purpose of this article is to (1) discuss efforts to integrate basic science into the clinical years of medical student education throughout the United States and Canada, and (2) describe the highly developed fourth-year basic science integration program at the University of Pittsburgh School of Medicine. In their critical review of medical school curricula of 126 U.S. and 17 Canadian medical schools, the authors found that only 19% of U.S. medical schools and 24% of Canadian medical schools require basic science courses or experiences during the clinical years, a minor increase compared with 1985. Curricular methods ranged from simple lectures to integrated case studies with hands-on laboratory experience. The authors hope to advance the national discussion about the need to more fully integrate basic science teaching throughout all four years of the medical student curriculum by placing a curricular innovation in the context of similar efforts by other U.S. and Canadian medical schools.

Publications and presentations resulting from required research by students at Mayo Medical School, 1976-2003

PURPOSE

To determine the research productivity related to required research experiences during medical school.

METHOD

The authors studied the research productivity of the 998 graduates at Mayo Medical School who had participated in a required third-year medical school research experience (21, 18, or 17 weeks long) between 1976 and 2003. Outcomes were verified published research reports and abstracts, and presentations at scientific meetings. Research reports and abstracts related or unrelated to the required research were distinguished.

RESULTS

Seventeen of the graduates were excluded when considering authorship of research reports (ambiguous data). Four hundred (41%) of the remaining 981 graduates published one or more research reports related to their required research experience, 176/998 (18%) published one or more abstracts related to their required research project, and 375/920 (41%) presented research findings at an extramural meeting at least once. Graduates who published a research report or abstract related to their required research or presented research at a scientific meeting published more research reports unrelated to their required research than did their peers who did not publish or present their required research (all P < .05). More graduates in the 21-week group were first authors (203/584; 35%) than were those in the 17/18-week group (60/336; 18%, P = .001), but other outcomes were similar for different durations (P > OR = .17).

CONCLUSIONS

Required medical school research experiences facilitate tangible research products and may promote subsequent research productivity. Shorter experiences seem to yield outcomes similar to longer experiences.

The new University of Colorado medical school curriculum: a pediatric perspective

The University of Colorado School of Medicine has developed an innovative 4-year undergraduate curriculum. As a strong advocate for education and curriculum reform, Dr M. Douglas Jones Jr. created an environment for pediatrics to flourish in this new curriculum. Pediatric content has increased in all years of the curriculum, and pediatric faculty have had greater opportunities to teach and seek career development in medical education. In this report, we review the process that led to curriculum reform, provide an overview of the new curriculum design, and highlight examples of the positive impact this process has had on education in pediatrics. We hope that sharing our experience, may benefit others in medical education.

In-depth learning: one school's initiatives to foster integration of ethics, values, and the human dimensions of medicine

Today's medical student curriculum is a lock-step experience that provides a broad survey of medicine with little opportunity to pursue fully integrated, in-depth learning. To teach students about the human dimensions of health care, many schools simply have added courses that survey general areas such as ethics, values, and patient-doctor relationships. However, a superficial, broad-brush approach does not offer students sufficient opportunity to engage with these topics in substantive and meaningful ways. The authors propose that a theme-based, individualized, in-depth learning experience (in which students pursue a focused project comprehensively and in detail)--one that is an integral part of the curriculum--helps students learn to blend values and ethics with medicine in a way that cannot occur during rapid-paced topical survey courses. Furthermore, it is in the depths of a learning experience that one comes face to face with the realities of uncertainty: the realization that unanswerable questions outnumber answerable ones; the awareness of the difficulty in accumulating sufficient evidence to answer a question that is, in fact, answerable; the recognition that many patients' problems transcend available evidence and must be addressed by the art of medicine; the realization that a patient can have a condition that one cannot diagnose and that may even get better for reasons that one cannot understand. The authors describe three initiatives at the University of Pittsburgh School of Medicine, two of which have been offered for more than 10 years, that illustrate the value of in-depth learning experiences. These in-depth experiences blend situated learning, reflective exercises, faculty mentoring, critical reading of literature, and constructive feedback in a prescribed but individualized curriculum.

Supportive programs increase medical students' research interest and productivity

BACKGROUND

Advances in biomedical research during the last decade have highlighted the necessity of attracting greater numbers of physicians to careers that include a research component. Physician participation in research is essential to increase the number of clinical and translational studies performed, as well as to educate the public about the importance of clinical trials and to assist in recruiting participants. We hypothesized that attractive research opportunities that included faculty mentoring, recognition of participation, and rewards for accomplishments would encourage medical student participation.

METHODS

The Medical Student Research Office was created at Mount Sinai School of Medicine in 1996 to develop structured research programs and advise students looking to undertake a research project. Data from students participating in the summer research program and Medical Student Research Day, from the research section of the Medical Student Performance Evaluation, were collected from 1996 to 2004.

RESULTS

For the last 4 years, the majority of medical students did research following the first year of school. Students did basic and clinical research, although most preferred clinically oriented or translational projects. Participation in Research Day and the number of publications suggest that interest is growing, including that by traditionally underrepresented groups.

CONCLUSION

Although it is too early to assess the long-term effects, the research programs offered led to greater numbers of students who did research, including those in traditionally underrepresented groups. Moreover, students were highly satisfied with their experiences, with 80% feeling that it increased their interest in applying principles they learned to the practice of medicine.