Within weeks of completing his 3rd year of medical school at the University of Chicago, Shashank Sinha found himself at the U.S. National Institutes of Health revising and editing a phase IIa/IIb clinical trial protocol and representing his NIH mentor, cardiologist Mark Gladwin, at the trial's review meeting. "It was an incredible opportunity to see how clinical trials are designed, reviewed, and prioritized," says Sinha, who had joined Gladwin's lab for the year to study nitrite physiology. "I couldn't believe I was discussing this protocol with National Heart, Lung, and Blood Institute Director Elizabeth Nabel and cardiology legend Eugene Braunwald."

Last year, Sinha was one of 42 medical students living on the NIH campus for a year of research training as part of the Howard Hughes Medical Institute (HHMI)/NIH Research Scholars Program--known colloquially as the cloister program. The cloister program is what's known as a "year-out" program--one approach to solving the problem of how to provide medical students with a bolus of research experience during medical school without adding to the 4 to 6 years of training a Ph.D. would require. Some year-out programs result in a master's degree, and some medical schools take the approach of integrating research directly into the curriculum to give students a taste of what it's like to be a clinician-researcher. "I went to the cloister program to have an immersive research experience," Sinha says. "The year out really affirmed my desire to become a physician-scientist."

Year-out programs

Year-out programs have become increasingly popular since the Sarnoff Cardiovascular Research Foundation introduced the concept for medical students interested in cardiovascular science in 1979. The fellowship program continues today with up to 20 training slots offered each year. Sarnoff fellows are paid a stipend and conduct independent research for 1 year in the laboratory of cardiovascular scientist.


(Courtesy, Sinha Shashank)
Sinha Shashank

In 1985, HHMI partnered with NIH to create the cloister program, which is open to medical, dental, and veterinary students. In 1989, HHMI created the research university-based HHMI Research Training Fellowships for Medical Students--often called the Med Fellows Program. That program allows medical students to take a year off to work in a laboratory at an academic research institution.

"These two programs were envisioned to permit medical students the opportunity to conduct basic research," says William Galey, program director for HHMI's graduate education and medical research training programs. "However, early on there was a recognition that there is a lot of new science in cell and molecular biology and computational medicine that can be applied to medical practice. But that plethora of new knowledge wasn't being transferred, and we now have a commitment to including translational research."

On the NIH campus, the Clinical Research Training Program (CRTP) provides 30 medical and dental students a year the opportunity to work with a mentor on clinical or translational research projects. CRTP fellows develop individualized learning plans with the help of an NIH mentor. In addition to time spent at the bench, fellows participate in peer-group discussions, attend outpatient clinics, and see patients enrolled in investigational protocols at the NIH Clinical Center.

New research tracks

Year-out programs need not necessitate a move. Many medical schools offer students the option to extend their stay to 5 years by incorporating a research year. What's more, that year out can often be parlayed into additional academic credentials, as many medical schools offer year-out programs that result in master's degrees in areas such as public health, clinical investigation, translational research, and patient-oriented research. Often, these programs fall under the aegis of NIH's Clinical and Translational Science Awards (CTSA).

Zach Borus, a University of Rochester medical student who envisions a career in community health, took advantage of such an opportunity. Borus says he knew he would need a background in research to be an effective family medicine practitioner. By joining the University of Rochester's Academic Research Track (ART), which is funded by a CTSA, Borus received support for a year off between his 3rd and 4th years of medical school to complete the coursework and research necessary for a master's in public health.

"I definitely see myself incorporating the skills I gained during my year out into my medical practice," Borus says. He hopes that as a physician, he'll be able to spearhead health literacy, nutrition, and school-based interventions using a community-based participatory research model. "The community helps develop the question to be asked and what their priorities are in terms of public health," Borus says. "You form a true partnership between the community and researchers and work together on the project and bring knowledge, jobs, and resources back to the community."

"The Academic Research Track is our effort to provide students a leg up to having a research component to their career," says ART Director Robert A. Gross, who notes that the program currently supports students who want the research experience without the need to pursue a graduate degree even though some students such as Borus do choose to complete degrees. It's a model that is employed under various frameworks in medical schools across the country. Undergraduate students who are interested in such opportunities should explore whether the medical schools they are considering offer such programs.

Research in medical school

While most medical students looking for an immersive research experience face the decision to extend their training in medical school, some medical schools, such as those at Stanford University and the University of Pennsylvania, have altered their 4-year curriculums to incorporate some time for research and other scholarly experiences.

Duke University Medical School pioneered this approach in the late 1960s when it compressed medical education to permit a full year of research as part of its medical curriculum. "We ask students who matriculate to spend up to a year in a scholarly pursuit of their choice, and we designed a curriculum that allows them to be prepared to do that," says Edward Buckley, vice dean for medical education at Duke.

Traditionally, medical school entails 2 years of basic medical science education in the classroom followed by 2 years of clinical rotations. Duke squeezes its basic medical science coursework into 1 year and sends students through their 1st year of clinical experiences before providing a year of research or other scholarly pursuits. Stanford, on the other hand, infuses research time throughout its curriculum, and Penn requires its students to complete a 3 to 5 month scholarly pursuit.

"The intent of this program is to invigorate the student body and hopefully instill the desire to pursue research during their careers," Buckley says. The approach appears to have generated success: Buckley reports that 20 years after graduation, one-third of all Duke Medical School graduates were publishing in the academic literature.

Duke's innovative curriculum is what drew Andrea Havens to the program. Now a 2nd-year resident in internal medicine at Vanderbilt Medical Center, Havens believes having the research year between her clinical rotations allowed her to focus her laboratory efforts on her clinical interests. "Duke does a really good job mentoring and getting you ready to maximize that year off," says Havens, who spent her year off as a Sarnoff fellow at Rockefeller University.

Havens enjoyed the laboratory environment so much that she stayed for a 2nd year. She even considered entering Duke's M.D./Ph.D. program but instead chose to enter a residency program that supported research efforts. At Vanderbilt, she is in a "fast track" residency that will compress three clinical-training years into two and allow her to focus on research during her 3rd year. (See also Making Room for Research During Residency.)

"I think a research experience outside of medical school is invaluable," she says, "because it allows you to get perspective and identify what you are really interested in. It's really hard to do that while you are in medical school and focused on the fact that you are taking tests and being evaluated all the time."

Only the beginning


(Courtesy, Jonah Cohen)
Jonah Cohen (also an amateur guitarist)

Taking a year out to conduct research or enrolling in a school with a research-focused curriculum doesn't fully prepare a student to become a physician-scientist. "We don't claim that a research year will provide all the training one needs to become an effective physician-scientist," Galey notes. "We hope it will inspire students to pursue additional training at the appropriate time."

After graduating, medical students may choose to further pursue research through a research residency, research fellowship, or a postdoc. But research experience during medical school serves as a critical steppingstone by providing an experiential background and a network of colleagues and mentors.

"It was really inspiring to see that people with M.D.s could be successful in an academic research setting," says Jonah Cohen, a 3rd-year medical student at Brown University who participated in the HHMI-NIH cloister program last summer. He credits his year out with clarifying his priorities as he plans a career in surgical oncology. "There is something very energizing about working with patients," Cohen says. "At the same time, if I was doing purely clinical work, I would feel that I wouldn't be contributing to moving the practice of medicine forward."

Getting Research Experience During Medical School

Year-out programs

Doris Duke Charitable Foundation.

Clinical Research Fellowship for Medical Students

This fellowship supports a medical student for 1 year of research at one of 12 selected institutions in the United States. Each institution solicits and evaluates applications. The Doris Duke Charitable Foundation supports a minimum of 60 domestic fellows and 12 international fellows.

Howard Hughes Medical Institute.

Research Training Fellowships for Medical Students

This fellowship supports 1 year of research at any academic or nonprofit institution in the United States, except the National Institutes of Health.

HHMI-NIH Research Scholars Program

Also known as the cloister program, participants live on the NIH campus for 9 months to a year for a research project and enjoy weekly dinner seminars with distinguished HHMI and NIH researchers. Program alumni routinely cite their colleagues and mentors as key benefits of the program.

NIH Clinical Research Training Program

This residential program houses 30 fellows within walking distance of the NIH campus, where they spend a year conducting translational or clinical research. Fellows enjoy lectures and close mentoring relationships.

Sarnoff Cardiovascular Research Foundation.

Sarnoff Fellowship Program

The original year-out program. It funds up to 20 fellows to conduct cardiovascular research at an institution other than their own.

Centers for Disease Control Foundation.

The CDC Experience Applied Epidemiology Fellowship

This 1-year fellowship is designed to increase the pool of physicians with a population health perspective.

PhRMA Foundation.

The Paul Calabresi Medical Student Research Fellowship

This PhRMA-sponsored fellowship supports medical students who are interested in pharmacology. Support ranges from 6 to 24 months.

Overseas Fellowships in Global Health and Clinical Research

The Fogarty International Clinical Research Scholars Support Center at Vanderbilt University offers a 1-year research experience to medical students interested in conducting research at top-ranked NIH-funded research centers in developing countries.

Integrated master's-degree programs

Many medical schools offer master's-degree programs in public health and clinical and translational research. The American Association of Medical Colleges maintains a list of these programs.

Research in medical school

The following are a selection of medical schools that incorporate research directly into their curriculum.

- Duke University School of Medicine

- Harvard-MIT Health Sciences and Technology

- Stanford University School of Medicine

- University of Pennsylvania School of Medicine

Lisa Seachrist Chiu is a science writer in Washington, D.C., and author of When a Gene Makes You Smell Like a Fish ... and Other Amazing Tales about the Genes in Your Body.

Lisa Seachrist Chiu is a science writer in Washington, D.C.
10.1126/science.caredit.a0900055