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Graduate Matters

The challenges and rewards of completing an MD-PhD

Meet three clinician-scientists who are interested in practicing medicine and conducting research.

BY BENNY DUA, JARED WILCOX & ZAHRA SOHANI | JAN 29 2020

In graduate school, the focus is usually on research (thesis stream) or knowledge creation through experiential learning (professional stream). However, the MD-PhD program is a unique option that actually bridges the two streams. The following three academics are doing just that: Benny Dua completed his MD-PhD at McMaster University and is currently completing his fellowship in the allergy and immunology program at McMaster; Jared Wilcox completed his MD-PhD at the University of Toronto and is currently a resident in McGill University’s neurosurgery postgraduate residency program; and Zahra Sohani completed her MD at the University of Toronto and PhD at McMaster. She is currently a resident physician at McGill University in internal medicine, an epidemiologist, as well as a writer.

What drew you to this combined MD-PhD program?

 

Benny: Initially, I was not intending to pursue any further research after completing my master’s, however, after spending time in my supervisor’s lab, I really enjoyed the research and the clinical application of my work. That was the impetus to applying for the combined MD-PhD.

Jared: I had previously worked in research for a master’s in stem cell biology. I had a strong interest in basic science and thought that the ability to continue to develop in research throughout medical training could lead to further advancements. I felt that if I could continue doing research throughout my residency, it could lead to developing a program towards advances to elevate spinal research. The MD-PhD seemed like a unique way to do that and develop with some flexibility before getting into a specific job track.

Zahra: My interest in the MD-PhD career came from seeing the possibility of asking scientific questions based on my experience with patients and finding solutions applicable to the bedside. As a clinician-scientist, I wanted to act as a catalyst of knowledge translation, with a fluency in basic science and access to patient care. This is what ultimately led me to pursue both an MD and a PhD.

How does the MD-PhD program function at your institution?

 

Benny: The MD-PhD program is a concurrent program where a student will spend a certain amount of time in each field throughout the projected seven years of study. At McMaster, this entails completing one year of your doctoral studies, then completing about 15 months of pre-clerkship, as part of the MD curriculum. After this, a student will finish their PhD in the next three years and afterwards, complete the clerkship portion of the MD program, which is another 19-20 months. At McMaster, the MD program is three years in duration.

Jared: While I was doing my MD-PhD the University of Toronto, the program was semi-integrated with a variable model. Despite the flexibility to structure as best suited to you, most did a PhD between pre-clerkship and clerkship. The combined program was not recognized as separate program then, which it is now, but had financial support throughout all years of training.

Zahra: Most MD-PhD programs are structured to allow fluidity between clinical training and research. The way in which I completed my degrees didn’t offer the fluidity, but instead I was able to focus all my attention on my research when I did my PhD. When I completed that, I was immersed on learning medicine when I was in medical school. There are certainly pros and cons to both approaches.

What’s involved with applying to this specialized program? How did you prepare for the application?

 

Benny: I applied to the individual MD and PhD programs, and met the requirements for each. In the last few years, this process has changed, and a separate application is required to put forth to the combined MD-PhD committee. Prospective applicants will be invited to complete a 12-station multiple-mini interview (MMI) that will be organized by this committee. To be successful in this program, an applicant must show a strong interest in research.

For me, I showed my interest in research by starting to pursue my master’s degree with my supervisor. In preparation for the interviews, I practiced answering questions with colleagues, reading around medical-legal cases and staying abreast of current topics in the news.

Jared: The process requires parallel application to the MD and MD-PhD streams. The MD-PhD application portion requires a personal essay, CV, three letters of reference, and a separate interview. I prepared for it with simple steps, ensuring I had all application elements done in advance and read about the program. I prepared for the interview with a plan for what I could do at that institution, and a flexible yet concrete idea of what research I would perform and with whom (that of course changed entirely). I didn’t have an exact idea for my research, or a speciality decided, just a fervor for research and clinical work.

Zahra: I did not apply directly to the MD-PhD program so I cannot specifically comment on this. However, as the work of a clinician-scientist entails bridging the gap between medicine at the bedside and scientific innovation, I would recommend highlighting skills integral to this role, such as critical thinking, strong communication skills, and a desire to engage in lifelong learning. I would also highlight each of these strengths with examples from the applicant’s previous experiences. Strong applicants are able to demonstrate an aptitude for skills that they will be expected to manifest in their future role as clinician-scientists.

Describe your current research project as well as your medical practice focus

 

Benny: My research project involved studying dendritic cells, which are antigen presenting cells, in the pathophysiology of allergic asthma. I was able to use the allergen challenge model to provoke airway obstruction and airway inflammation in patients with mild asthma. From this experience, I learned more in the areas of respiratory physiology and immunology, shaping and directing my career as I am now pursuing my fellowship in allergy and immunology.

Jared: I focused my PhD on stem cell transplants in spinal cord injury. I updated a model with rats, where the response to therapy was hand/paw function to reflect the primary goal of therapy in patients. I am still working on completing manuscripts from the PhD days.

Right now, I’ve transitioned to grants and easier activities (i.e. writing chapters and case studies) on single cell sequencing in the spinal cord and clinical management of cervical trauma. I plan to develop a project for fellowship in brain-machine interfacing using surface and depth electrodes to send motor cortex impulses directly to limbs to bypass spinal cord injury paralysis (neuroprosthetics). This will require me to train in both spine and epilepsy, two facets of neurosurgery not typically merged.

Zahra: My doctoral research focused on understanding genetic variation in ethnic susceptibility to cardiovascular disease. Specifically, I sought to compare the genetic architecture of diabetes among low- and high-risk ethnicities. I also focused on studying methods, both statistical and in research design. As such, some of the work I did was to further develop the methodology of systematic reviews and meta-analyses as well as create ways to understand variability in data. My previous knowledge of cardiovascular disease is certainly useful in my clinical practice of internal medicine. What I find even more useful is an understanding of research methodology because this allows me to critically appraise the evidence upon which we predicate our clinical decisions every day. I think this part of my PhD training will help me become a better physician and provide the best care to my patients.

What were the most rewarding experiences in completing this program?

 

Benny: Exposure to both the bench and bedside practice gave me an appreciation for both basic and clinical science. I was able to assist with clinical trials, seeing firsthand how medical research can influence treatment strategies for asthma. Furthermore, through my own research, I was able to better under the pathophysiology of asthma, and witness the study of various asthma drugs that target dendritic cells.

Jared: I think my most rewarding moments from the MD-PhD program were the lifelong friends I made, the trips for international conferences, and the feeling that I was completing work of a high calibre in my field. Moreover I was able to teach over a dozen medical students, residents, and fellows, and felt that I left the lab and community better than I found it.

It was a special highlight to meet surgeons across the country, and some world leaders. I was president of the clinician investigator trainee association committee, and that was an amazing way to meet and work with ‘my tribe.’ Overall, the most rewarding experience of the combined program was completing it finally.

Zahra: During my medical school years, I started a seminar series where we organized lectures and workshops for fellow medical trainees in conducting research. These included a session on how to conduct a systematic review. I found this to be one of the most rewarding experiences because I was able to take the knowledge afforded to me by my PhD training and use it to help my fellow medical trainees become better clinicians and clinician-scientists. I continued this series in residency and it has been equally as rewarding.

What were some of the challenges you faced?

 

Benny: Ironically, the most rewarding part of my experience was also my most challenging. Having to switch back and forth between research and clinical medicine is not easy, as each requires its own set of skills and ways of thinking. Furthermore, to build and sustain one’s medical knowledge and clinical skills, along with keeping abreast of relevant research in the filed of study, is also very challenging. This experience taught me the importance of time-management, and also, how to navigate between basic and clinical medicine.

Jared: The absolute biggest challenge was the repeated failures that I had to find a way to circumvent. Searching for a new way through these barriers was rewarding, but also led to my strongest feelings of burnout. It wasn’t an easy path and led to a lot of self-realization and forced me to find new ways of making-it-through.

Pushing past logistic and bureaucratic barriers in the lab was also frustrating but rewarding when successful. It seems there is always conflict within labs with strong personalities. However, if you stay calm and keep your eyes up, you can learn ways to deal with strong and abrasive personalities in the other domains of life.

Zahra: A challenge that I specifically remember is the transition from being an adult and independent learner during the PhD years to going back to the classroom during the medicine years. It often felt uncomfortable to go from being an expert in a certain field to not knowing anything as a medical student and being taught didactically. However, the experience was humbling and reminded me that one will never know enough and the meaning of being a clinician scientist is to engage in lifelong learning, no matter how uncomfortable it may feel at the start.

What advice would you give to someone considering applying to a MD-PhD program?

 

Benny: Remember that the journey may be long but it is a rewarding and fruitful experience. It will allow you to become a leader in both medical research and patient care.

Jared: First and foremost, make sure this is what you want. Second, have some hands- on-research experience. It is more important to find out if you really dislike research in the lab and just enjoyed the idea of doing science. This is the true value of a summer research project. Lastly, I suggest talking to different stakeholders in the program to have a complete view of what learning looks like, including current MD-PhD trainees, lab members of the Investigators you want to work with and the MD-PhD program director. After all, you will be dedicating a decade of your life to the program.

Zahra: The MD-PhD track is a marathon, not a race. As such, you should prepare yourself for learning and hard work over a lifetime. You should also find things outside of medicine and research that bring you joy. It is the balance of life and living other aspects of our life to the fullest that will help us successfully complete the marathon.

ABOUT BENNY DUA, JARED WILCOX & ZAHRA SOHANI
Benny Dua is completing his fellowship in the allergy and immunology program at McMaster University, Jared Wilcox is a resident in McGill University’s neurosurgery postgraduate residency program, and Zahra Sohani is  a resident physician at McGill University in internal medicine, an epidemiologist, as well as a writer.
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