Examining Summer Laboratory Research Apprenticeships for High School Students as a Factor in Entry to MD/PhD Programs at Matriculation

Addressing the need to facilitate undergraduate research experiences for community college transfer students in science

Community college transfer students face numerous challenges, including gaining access to undergraduate research experiences. In this Perspectives piece, we articulate the benefits of undergraduate research experiences for community college transfer students, some of the common barriers for engaging transfer students in undergraduate research, and how 4-year institutions can address these problems through the development of transfer-specific programs. We specifically discuss the LEAP Scholars program, which we designed for low-income community college transfer students. The LEAP Scholars program helped students learn about undergraduate research through their participation in a science education course-based undergraduate research experience and facilitated student access to undergraduate research experiences in science faculty member research labs.

Diversity in MD-PhD Programs and Factors Affecting Admission and Completion Among Minoritized Groups: A Scoping Review

PURPOSE

To improve awareness of diversity in MD-PhD program applicants, matriculants, and graduates; facilitators and barriers to matriculation and/or completion among minoritized groups; and the effects of research experience programs on admissions processes aimed to increase representation of minoritized groups in MD-PhD programs.

METHOD

The authors conducted a scoping review, searching EMBASE, MEDLINE, PsycINFO, CINAHL, and Web of Science through December 21, 2021, for studies that contained data on the characteristics of MD-PhD learners and initiatives aimed to make the clinician-scientist trainee population more diverse. They excluded studies that had no primary data, were unavailable in English, and were not peer-reviewed.

RESULTS

Of 4,369 articles identified, 16 met inclusion criteria. Studies conceptualized diversity inconsistently, including as sex/gender disparities (n = 11), race/ethnicity underrepresentation (n = 9), disability (n = 2), first-generation student (n = 1), visible minority (n = 1), Indigenous population (n = 1), and economic/social disadvantage (n = 1). Potential barriers to entering or continuing in an MD-PhD program among women and underrepresented ethnic minorities included the long program duration and lack of mentorship; potential facilitators included the flexibility of the dual-degree program. Limited data on high school, undergraduate, and postbaccalaureate research experience programs targeting underrepresented minorities suggest that they may help facilitate admission into MD-PhD programs.

CONCLUSIONS

The findings of this scoping review suggest that the diversity of MD-PhD students has been conceptualized in unitary, inconsistent terms, without addressing how different dimensions of diversity may intersect and impact MD-PhD admissions. Future studies should be explicit and intentional in defining "diversity" as it relates to their research questions, explore the impact of intersectionality, and systematically identify and address causal facilitators and barriers of entry to and completion of MD-PhD programs among minoritized groups.

Reflections on undergraduate research mentoring

Recruiting talented high school and college students to consider a career in the biomedical or biophysical sciences is important, yet often difficult. Encouraging students in regions like Appalachia adds additional challenges due to socioeconomic hurdles and misperceptions. This brief report contains the reflections of a research mentor engaging with students as a high school physics teacher, a principal investigator at research-intensive university, and as a principal investigator at a predominantly undergraduate-focused research university, as well as the viewpoint of a former undergraduate student in the mentor's lab. Different hurdles stand in the way of success at each level. A key issue at the high school level is engaging students in 'real science', the discovery of new knowledge and ideas. With undergraduate students at a larger research institution, a key issue is for the student to have opportunities to engage in meaningful scientific research. At a smaller and more rural research institution, especially in Appalachia, many students have socioeconomic concerns and misconceptions of what scientific careers entail. Regardless of background and environment, there are certain students who thrive on the scientific curiosity to discover new things. All they need is that opportunity to engage in meaningful scientific discovery to become interested in a scientific career.

EXPLORING REASONS THAT U.S. MD-PHD STUDENTS ENTER AND LEAVE THEIR DUAL-DEGREE PROGRAMS

AIM/PURPOSE

In response to widespread efforts to increase the size and diversity of the biomedical-research workforce in the U.S., a large-scale qualitative study was conducted to examine current and former students' training experiences in MD (Doctor of Medicine), PhD (Doctor of Philosophy), and MD-PhD dual-degree programs. In this paper, we aimed to describe the experiences of a subset of study participants who had dropped out their MD-PhD dual-degree training program, the reasons they entered the MD-PhD program, as well as their reasons for discontinuing their training for the MD-PhD.

BACKGROUND

The U.S. has the longest history of MD-PhD dual-degree training programs and produces the largest number of MD-PhD graduates in the world. In the U.S., dual-degree MD-PhD programs are offered at many medical schools and historically have included three phases-preclinical, PhD-research, and clinical training, all during medical-school training. On average, it takes eight years of training to complete requirements for the MD-PhD dual-degree. MD-PhD students have unique training experiences, different from MD-only or PhD-only students. Not all MD-PhD students complete their training, at a cost to funding agencies, schools, and students themselves.

METHODOLOGY

We purposefully sampled from 97 U.S. schools with doctoral programs, posting advertisements for recruitment of participants who were engaged in or had completed PhD, MD, and MD-PhD training. Between 2011-2013, semi-structured, one-on-one phone interviews were conducted with 217 participants. Using a phenomenological approach and inductive, thematic analysis, we examined students' reasons for entering the MD-PhD dual-degree program, when they decided to leave, and their reasons for leaving MD-PhD training.

CONTRIBUTION

Study findings offer new insights into MD-PhD students' reasons for leaving the program, beyond what is known about program attrition based on retrospective analysis of existing national data, as little is known about students' actual reasons for attrition. By more deeply exploring students' reasons for attrition, programs can find ways to improve MD-PhD students' training experiences and boost their retention in these dual-degree programs to completion, which will, in turn, foster expansion of the biomedical-research-workforce capacity.

FINDINGS

Seven participants in the larger study reported during their interview that they left their MD-PhD programs before finishing, and these were the only participants who reported leaving their doctoral training. At the time of interview, two participants had completed the MD and were academic-medicine faculty, four were completing medical school, and one dropped out of medicine to complete a PhD in Education. Participants reported enrolling in MD-PhD programs to work in both clinical practice and research. Very positive college research experiences, mentorship, and personal reasons also played important roles in participants' decisions to pursue the dual MD-PhD degree. However, once in the program, positive mentorship and other opportunities that they experienced during or after college, which initially drew candidates to the program was found lacking. Four themes emerged as reasons for leaving the MD-PhD program: 1) declining interest in research, 2) isolation and lack of social integration during the different training phases, 3) suboptimal PhD-advising experiences, and 4) unforeseen obstacles to completing PhD research requirements, such as loss of funding.

RECOMMENDATIONS FOR PRACTITIONERS

Though limited by a small sample size, findings highlight the need for better integrated institutional and programmatic supports for MD-PhD students, especially during PhD training.

RECOMMENDATIONS FOR RESEARCHERS

Researchers should continue to explore if other programmatic aspects of MD-PhD training (other than challenges experienced during PhD training, as discussed in this paper) are particularly problematic and pose challenges to the successful completion of the program.

IMPACT ON SOCIETY

The MD-PhD workforce comprises a small, but highly -trained cadre of physician-scientists with the expertise to conduct clinical and/or basic science research aimed at improving patient care and developing new diagnostic tools and therapies. Although MD-PhD graduates comprise a small proportion of all MD graduates in the U.S. and globally, about half of all MD-trained physician-scientists in the U.S. federally funded biomedical-research workforce are MD-PhD-trained physicians. Training is extensive and rigorous. Improving experiences during the PhD-training phase could help reduce MD-PhD program attrition, as attrition results in substantial financial cost to federal and private funding agencies and to medical schools that fund MD-PhD programs in the U.S. and other countries.

FUTURE RESEARCH

Future research could examine, in greater depth, how communications among students, faculty and administrators in various settings, such as classrooms, research labs, and clinics, might help MD-PhD students become more fully integrated into each new program phase and continue in the program to completion. Future research could also examine experiences of MD-PhD students from groups underrepresented in medicine and the biomedical-research workforce (e.g., first-generation college graduates, women, and racial/ethnic minorities), which might serve to inform interventions to increase the numbers of applicants to MD-PhD programs and help reverse the steady decline in the physician-scientist workforce over the past several decades.

Transition Experiences in MD-PhD Programs

MD-PhD training takes, on average, 8 years to complete and involves two transitions, an MD-preclinical to PhD-research phase and a PhD-research to MD-clinical phase. There is a paucity of research about MD-PhD students' experiences during each transition. This study examined transition experiences reported by 48 MD-PhD students who had experienced at least one of these transitions during their training. We purposefully sampled medical schools across the United States to recruit participants. Semistructured interviews were audio-recorded and transcribed for analysis; items focused on academic and social experiences within and outside their programs. Using a phenomenological approach and analytic induction, we examined students' transition experiences during their MD-PhD programs. Five broad themes emerged centering on multiple needs: mentoring, facilitating integration with students in each phase, integrating the curriculum to foster mastery of skills needed for each phase, awareness of cultural differences between MD and PhD training, and support. None of the respondents attributed their transition experiences to gender or race/ethnicity. Students emphasized the need for mentoring by MD-PhD faculty and better institutional and program supports to mitigate feelings of isolation and help students relearn knowledge for clinical clerkships and ease re-entry into the hospital culture, which differs substantially from the research culture.