Therapeutic applications are undoubtedly one of the most attractive and tangible fruits of the frequently drawn-out and frustrating research process. The prospect of contributing to medical progress is a motivating factor for many scientists. But what motivates clinicians to spend time away from the bedside at the bench?
Research Not Easy for German Doctors
German doctors don't have an easy time in research. Medics who wish to conduct research are usually forced to take time out from their studies and clinical training, prolonging an already lengthy qualification period. Nevertheless, the majority of medical students conduct a so-called Doktorarbeit (doctoral work), and the title Dr. med. (M.D.) is awarded after the successful completion of a thesis.
However, not all Dr. med. are created equal: The depth of thesis research undertaken is extremely variable. Some students opt for straightfoward desk research--the statistical analysis of a therapautic regimen, for example--whereas others opt for an extensive basic experimental project. The result? The research stint can take anywhere from 6 months to several years, but the final qualification is offically the same: There is no system in place to give credit for an in-depth doctoral thesis versus a more superficial one.
Even with an outstanding M.D. thesis in hand, the medical career structure is still unfavourable for those who would like to devote more time to research. Interestingly, over the last 2 years, new, although still rare, opportunities for medical graduates to apply for a combined clinical/research internship, where time in the lab is offically part of their training, are starting to appear in some universities. Earlier generations of medics bitten by the research bug have been left with no choice but to somehow juggle their professional lives so they can undertake both clinical and scientific work.
So why do it? "I have been extremely interested in nature and science since I was a child," explains Philipp Beckhove, who supervises a research team of eight people at the German Cancer Research Centre (DKFZ) in Heidelberg. As a student Beckhove took time out from his medical education to take biology lectures and practical courses. He explains that the beauty of research is that "it allows you to follow your own ideas. Every day you have the potential to find something new, whereas in clinical medicine, naturally one has to stick to the strict protocols."
"The personal liberty and autonomy of research contrasts with a much more routine working life in clinical medicine," agrees Marcus Möller, who leads a research group in the Institute of Anatomy at Heidelberg University.
The Clinic Has Its Rewards
However, the researchers Next Wave spoke to aren't in a hurry to turn their backs on the clinic forever. All concede that they miss the rewards and satisfaction of dealing with patients. Furthermore, having a clinical background and the personal experience of treating patients gives an important perspective to their research. Paediatrician Cécile Dau, currently researching childhood kidney disease as a postdoc, feels that her clinical experience is a great motivator when dealing with the trials and tribulation of a research project. Beckhove also has observed that his medical doctoral students sometimes have visibly heightened motivation in the lab compared to pure biologists. Meanwhile, DKFZ postdoc Henning Schulze-Bergkamen believes that a clinician can make more realistic connections between research findings and potential therapeutic strategies.
Similarly, all felt that their research experience has benefited their clinical practise, by helping them make good judgements on the validity of published research data. Additionally, Dau says, the problem-solving skills that one develops in a lab pay off greatly when you go back to the hospital: "You simply learn how to organise and plan your time more effectively."
But given the lack of a research career track for medics, is it possible to do both? Alexander Marmé is a gynaecologist and obstetrician. He has previously spent periods of time exclusively devoted to research. At the moment, though, he is employed as a full-time clinician at a university hospital--and concurrently works on four research projects, from fundamental science to clinical trials. Marmé admits that it is his "fascination with science" that drives him to spend so much of his free time doing research. Just as well, as he is given no real concessions in the hospital staffing structure to take into account his active research interests. In fact he feels that, in the intensely competitive professional environment that is a good university hospital, his research interests are sometimes viewed rather negatively by his colleagues.
Research Needed for University Career
Doing research and clinical work in parallel inevitably means that one has to burn the candle at both ends, so Marmé does not particularly recommend his strategy. He believes that, in the longer term, careerwise it would be more advantageous instead for clinicians to form strong collaborations with scientists and then try to stay out of the lab!
How necessary is it, then, for trainee doctors to spend time at the bench? Schulze-Bergkamen thinks that it is only really essential for those who want to pursue a university career. But for those who are serious about heading down that track, he recommends concentrating exclusively on research for a while, "for example, by doing a 2-year postdoc," although probably only after getting 2 or 3 years of clinical experience. Beckhove also agrees that it is worth taking the time to do an in-depth research project at some stage. He suggests that medical students should give themselves the time at least "to do a really good M.D." with perhaps a view to a postdoc later on.
The danger, of course, is that time at the bench will diminish bedside skills. The clinician researchers Next Wave spoke to all stressed that it is not advisable to stay out of the hospital for prolonged periods of time, 2 years often being cited as the recommended maximum. Furthermore, moving from research to clinical work and back to research slows down career development, meaning it takes longer to qualify in a clinical speciality, for example.
In fact, thinks Beckhove, sooner or later the clinician who also has a talent for research may have to choose between the two. To be a good clinician requires years of experience, he stresses, and in a university hospital medical consultants simply have too many clinical duties to be very active in research. Möller equally feels that there is incompatibility in the career structure, and furthermore, that the two professions often don't fully appreciate or respect each other.
Whether a better dual-career structure can be developed remains to be seen. A recent encouraging change has been the launch of M.D./PhD. programmes  and the combined clinical/research internships at several German universities. Next Wave will review the preliminary experiences of these programmes in the coming weeks. In the meantime the present generation of medical doctors are certainly stretching themselves personally. The quest for excellent research should not be at the expense of the researchers themselves.