Opportunity: Newly Created Physician-Scientist Research Pathway by the American Board of Pathology

Physician-scientists in the United States at 2020: Trends and concerns

Physician‐scientists comprise a unique and valuable part of the biomedical workforce, but for decades there has been concern about the number of physicians actively engaged in research. Reports have outlined the challenges facing physician‐scientists, and programs have been initiated to encourage and facilitate research careers for medically trained scientists. Many of these initiatives have demonstrated successful outcomes, but there has not been a recent summary of the impact of the past decade of effort. This report compiles available data from surveys of medical education and physician research participation to assess changes in the physician‐scientist workforce from 2011–2020. Several trends are positive: rising enrollments in MD‐PhD programs, greater levels of interest in research careers among matriculating medical students, more research experience during medical school and rising numbers of physicians in academic medicine, and an increase in first R01 grants to physician‐scientists. However, there are now decreased levels of interest in research careers among graduating medical students, a steady decline in MDs applying for NIH loan repayment program support, an increased age at first R01 grant success for physicians, and fewer physicians reporting research as their primary work activity: all of these indicators create concern for the stability of the career path. Despite a recommendation by the Physician‐Scientist Workforce in 2014 to create “real‐time” reporting on NIH grants and grantees to help the public assess trends, this initiative has not been completed. Better information is still needed to fully understand the status of the physician‐scientist workforce, and to assess efforts to stabilize this vulnerable career path.

The crisis in the pathology subspecialty fellowship application process: Historical background and setting the stage

The process whereby pathology residents apply for fellowships for subspecialty training after residency has long been fraught with multiple problems. This paper reviews the history of the creation of such fellowships, as tied to requirements for eligibility for certification by the American Board of Pathology, going back to the inception of the Board in 1948. The problems with fellowship applications began to appear in conjunction with changes in Board requirements for basic certification, revolving around the “fifth year” or “credentialing year” requirements, and have created a situation where now residents mostly apply for fellowships while still in the second of their 4-year AP/CP residency. The pressures to apply ever-earlier, to accept offers with short intervals between offer and expiration, and how this damages programs, as well as residents, are reviewed. This paper is a companion to a larger examination of the current status of this problem, which also explores some means to ameliorate or eliminate those problems.

Incorporation of autopsy case-based learning into PhD graduate education: a novel approach to bridging the "bench-to-bedside" gap

Given the current rapid expansion of biological knowledge and the challenges of translating that knowledge into clinical practice, finding effective methods of teaching graduate students clinical medicine concepts has become even more critical. The utility of autopsy in medical student and resident education has been well established. Multiple studies have reported it to be a helpful means of teaching anatomy, pathophysiology, clinical problem-solving skills, and medical diagnostic techniques. Although various models of training PhD candidates in clinical medicine have been reported, an autopsy-based curriculum has not been previously described. For over 4 years, our pathology department has offered a novel semester-long autopsy-based course to educate future Cellular and Molecular Pathology scientists about clinical medicine. Our results indicate that this "hands-on" approach is a popular as well as effective means of teaching the pathogenesis of disease at the level of the cell, organ, and patient. The course reputation has recently led to requests to open registration to graduate students from other university programs as well as undergraduate students. Additionally, it has played an important role in our Cellular and Molecular Pathology program's recent receipt of a 5-year renewal National Institutes of Health-funded T32 award. Overall, this course model has been successful at our own institution and could provide a useful template for other institutions seeking to provide graduate investigators with in-depth exposure to clinical medicine.