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The MD/PhD trek is a long journey, full of challenges, surprises, and excitement at every turn, but the rewards of contributing to new knowledge and the health of people, by bringing discoveries from the bench to bedside and back again, are limitless. Please read on for a view of the impending medical revolution from the front lines: the MD/PhD student's perspective.

Canada has nine MD/PhD dual-degree programs. Although subtle variations exist, for the most part MD/PhD programs are very similar across Canada. For this reason, I will primarily describe the University of British Columbia (UBC) MD/PhD model and share with you my experiences.

The UBC MD/PhD program is a 7-year, integrated program jointly offered by the Faculty of Medicine and the Faculty of Graduate Studies. In addition to fulfilling the requirements of the regular 4-year MD curriculum, MD/PhD students also undertake graduate-level coursework and research as recommended by a supervisory committee. As with the traditional PhD, MD/PhD students must successfully complete an oral comprehensive examination, as well as write and defend their thesis by oral examination. The UBC MD/PhD training path capitalizes on the systems-oriented and multidisciplinary approach of the MD curriculum to allow overlap and concurrent activities in clinical training and research. This facilitates the timely completion of the MD/PhD degree with the least possible interruption in either clinical experiences or research endeavours. Moreover, some flexibility in approach often exists, allowing the further customization of the program to meet the unique career goals of students based upon their background, previous research experience, and their chosen medical field of expertise.

Identify supervisor, secure funding

So what does this really mean and how is this reflected in the daily experience of a MD/PhD student? As with most Canadian programs, the first year of the UBC MD/PhD program is identical to the traditional first-year MD curriculum. However, during this year the MD/PhD student is also required to identify a research supervisor and hosting department, and to secure funding. Although these may sound like daunting tasks, particular advantages are gained over the conventional PhD stream. For instance, whereas a PhD student would normally pursue a supervisor by performing literature or Web-based searches, an MD/PhD student is introduced to a wide variety of local medical research disciplines and potential supervisors in lecture or clinical settings.

Moreover, funding for MD/PhD students is readily available at both the national level (for example, the Canadian Institutes of Health Research MD/PhD Studentship) or provincial level (as in British Columbia's Michael Smith Foundation for Health Research PhD Trainee Award), although not all provinces have such awards. As an added bonus, some of these awards provide funding over even the more clinically oriented years of MD/PhD programs. Upon the completion of the first-year medical curriculum, the summer is spent setting the stage for the research component. At this time students may draft research proposals, set up a supervisory committee, and begin thesis research and/or graduate level courses.

The early MD/PhD years take one on an incredible journey from the depths of a cell's nucleus, through body tissues and systems, the human being as a whole, our interactions with each other, and with the cosmos. Whereas at some schools one would continue on with the first semester or complete curriculum of second-year medicine prior to concentrating on research, the UBC model provides the option of a unique and integrated program format which strikes a balance between thesis coursework and research, medical classes and clinical experience, saving room for socialization and travel to exciting international conferences.

While offering its advantages (such as minimizing prolonged periods of time spent away from clinical or research experience, and effectively maximizing time allotted for thesis research), this approach can be more challenging. That is, even though research is not an official requirement during periods of medical training, it is often impractical not to keep a hand in the lab. This can cut into study time. But if absorbing and regurgitating already-known facts isn't your cup of tea, we feel that the skills, knowledge, and experience gained from maintaining one's research focus during medical school outweigh the challenges imposed.

Holistic experience, broader perspective on research

Specifically, the integrated UBC MD/PhD model provides a holistic experience whereby insights gained in medical school courses can provide a broader perspective on one's research and vice versa. Of course, nonintegrated MD/PhD programs can also offer this but the integrated UBC approach allows for concurrent complementation. Finally, for someone interested in a career in medical research, an MD/PhD program is advantageous in that it presents a student with an overview of all of human disease, highlighting areas most in need of research and exposing one to aspects of human health they might not have experienced in a customary PhD program.

Upon completion of the PhD, every Canadian MD/PhD program has its students rejoin the MD curriculum for the clerkship years (MD program years 3 and 4). As the PhD component has drawn MD/PhD students away from clinical medicine for varying periods of time (as little as 1 year, as in the case of the UBC integrated program, to as much as 5 years for other programs), reintegration can pose a bit of a challenge. MD/PhD programs have devised two approaches to combat this clinical hiatus. At some schools, the second semester of second-year medicine is completed at this time, prior to entering clerkships. At UBC, a summer rural practice experience allows students to refresh their memory and hone their clinical skills under the direction of excellent rural mentors.

Ultimately, however, faced with a mountain of facts and algorithms over the first 2 years of medicine, even students of the regular MD curriculum forget many things! It is our experience that MD/PhD students are often pleasantly surprised with how much they do remember, especially when prompted. Moreover, skills gained during the PhD (for instance, logical reasoning and problem-based learning) are advantageous on the wards. Also, depending on an MD/PhD student's area of research, one may run into like-minded clinicians during clerkships, which may serve as a unique opportunity to foster future collaborative research. Finally, MD colleagues with whom one started medical school may now turn up being one's senior resident on particular rotations (an advantage if you've been friendly)!

The extraordinary wealth and pace of research ushered in by the functional genomic and proteomic era will pose a particular challenge to the translation of such findings for the benefit of human health. Clinical experience and acumen can identify pertinent and urgent targets upon which to hone such technology, but a dialogue must be established between both sides. The impending medical revolution will require the concerted and coordinated effort of researchers, clinicians, and hybrids alike. MD/PhD graduates are ideally poised to meet such challenges by bridging the gap between modern biology and medical practice, and serving as a conduit for communication and change.

In this short review I've tried to give you an idea of what an MD/PhD program is like from a student's perspective. I'm sure many of you still have questions. Please feel free to peruse our program Web site and meet some of our current students, or send us an e-mail. Although a lengthy and challenging route, an MD/PhD program is an excellent investment that opens many doors, ultimately allowing a student to pursue a research-intensive track of residency and postdoctoral training in a specialty or discipline of their choice, leaving one well poised to partake in a medical revolution.