EVOLUTION OF MD-PhD TRAINING – HISTORY OF THE NATIONAL ASSOCIATION OF MD-PhD PROGRAMS AND AAMC GREAT GROUP MD-PhD SECTION
Olaf S. Andersen
The 1990s were a period of major changes in the evolution of MD-PhD training and the MSTP. Lee van Lenten, M.D., retired as NIH Program Director for the MSTP in 1995; he was succeeded by Bert I. Shapiro, Ph.D., who served until 2011. During his tenure as Program Director, Dr. Shapiro served as advisor and mentor to numerous Program Directors, and he had input on many of the developments summarized below.
The major changes grew out of the Annual National MD-PhD Student Conferences in Aspen, CO, which since 1986 had been organized by the University of Colorado MSTP to create a forum where students from MD-PhD Programs across the US meet to present research and network with other MD-PhD students. As the students returned home, they were aware of developments in other Programs, more so than many Directors, which motivated an increasing number of Directors to attend the Student Meetings ⎯ to monitor how their students compared with students in other programs and to network and exchange ideas about best practices that they could use in their own Programs.
By 1994, so many Directors attended the Student Meeting that Peggy Neville and Arthur Gutierrez-Hartmann (outgoing and incoming Director, respectively, of the Colorado MSTP) decided to host a separate Directors’ Meeting in 1995 to create a venue for more extended discussions relating to the training of MD-PhD students. The meeting was successful, and George Abraham (at the time Director of the University of Rochester MSTP) sent out an invitation to all Program Directors encouraging them to attend the 1996 Directors’ Meeting. Several dozen Directors accepted the invitation, and decided to form the National Association of MD-PhD Program Directors to facilitate an open exchange of “best and worst” practices and thus help all program directors to continuously improve the training of MD-PhD students. This decision was affirmed in 1997, when Paul A. Insel (Director of the UC San Diego MSTP) was chosen to be president of the Association.
Over the next five years, the number of Programs participating in the meetings, which continued to be held in conjunction with the Student Meeting, increased from about 35 to about 70. The driving force behind the Association’s growth was the common interest in training physician-scientists − in exchanging information regarding recruitment, admissions, curriculum, programmatic activities, career counseling, and outcomes. The Association’s meetings continued to be organized by the Colorado MSTP, where Dr. Gutierrez-Hartmann and Ms. Terri Wood (Program Administrator at Colorado) worked together with a dedicated group of Directors and Administrators from other Programs, who formed the Program Committee.
Beginning in 1998, the Program Administrators began to organize their own meetings ⎯ to network and organize workshops covering the practical aspects of effective management of an MD-PhD Program. These workshops led to the tradition that Bert Shapiro and Marcia L. Hahn (Grants Management Analyst at NIGMS) became regular presenters at the Association’s annual meetings. Dr. Shapiro summarized the state of research training at NIH and NIGMS; Ms. Hahn conducted tutorials on how to prepare an MSTP application. Due to limited funds (the NIH training budget did not increase while the NIH budget doubled), the number of funded Programs increased only modestly, from 33 in 1996 to 39 in 2005, but the application process became demystified, and expectations became more explicit, which was invaluable for all Programs.
At the meetings, the Administrators also compiled the matriculation database, which allowed all Programs to track where their accepted applicants matriculated ⎯ and thus enabled the Programs to evaluate their admissions and recruiting strategies. The Administrators also were instrumental in the development of listserves to ensure effective communication among the programs throughout the year, especially during the final weeks of the admissions season, which contributed to increasing cooperation and consultation among the programs. Recognizing the Administrators’ increasing importance for the Association’s activities, the Association’s name was changed to the National Association of MD-PhD Programs in 2003.
The Association was a volunteer-driven organization; individual Directors or Administrators spearheaded initiatives that the Association’s members deemed to be important for the training of MD-PhD students. The first such initiative, to collect data about the performance of MD-PhD students on the United States Medical Licensure Examination (USMLE) to justify a petition to USMLE to relax the so-called Seven-Year Rule (that all three steps of the USMLE should be completed within seven years), was undertaken by Olaf S. Andersen (director of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MSTP) and Paul Insel. The petition was successful, although the Seven-Year Rule was relaxed only for students who pursued their thesis research in the biomedical sciences. This greatly simplified the life of MD-PhD students ⎯ but it may have eliminated one of the driving forces to graduate in a timely manner. Many other important issues, however, such as the development of a common MD-PhD application or Traffic Rules for admissions to MD-PhD Programs were beyond the Association’s reach because it lacked the authority to impose policies on member programs. Nor did the Association’s organizational structure encourage the development of resources for prospective applicants.
As the Association grew, the limitations imposed by its structure became increasingly apparent. Though the Association received some administrative support from the Association of American Medical Colleges (AAMC), thanks to David Korn, M.D., Senior Vice President for Biomedical & Health Science Research at AAMC, the Association faced two major challenges: lack of recognition as being the principal organization with expertise in MD-PhD training, meaning that many decisions influencing the training of MD-PhD students were made without consulting the Association; and lack of sufficient infrastructure to undertake important initiatives ⎯ including organizing the Association’s annual meetings, which became more challenging as the Association grew.
The limitations became clearly visible at the Association’s 2003 meeting. Soon after the meeting, David Korn reached out to the Association’s leadership to propose that the Association establish closer ties with AAMC ⎯ possibly becoming an “entity” within AAMC. A group of Directors, led by Olaf S. Andersen, met with David Korn and AAMC staff to discuss the various possibilities. Though there were concerns about the loss of independence, the advantages (increased administrative support, having an AMCAS MD-PhD application, which would enable better collection of data about MD-PhD applicants, and access to AAMC data bases, which would allow for national outcomes studies) were compelling.
The end result was that the Association was mapped on to a new MD-PhD Section within the AAMC Group on Research Education and Training (GREAT). The Association would continue to exist, which allow for initiatives that might be difficult to pursue as an AAMC entity. Moreover, the Section would be able to organize its own meetings (every other year), which could be held in conjunction with the Student Meetings. The formation of the MD-PhD Section, which included the Program Administrators, was approved at the GREAT Group’s Annual Meeting in 2004; the inaugural meeting of the MD-PhD Section took place in conjunction with the GREAT Group’s 2005 meeting. Finally, the time had come to move on the many ideas that for years had been discussed at the Associations’ meetings.
The importance of maintaining the Association, and the freedom it provided, was apparent during formation of the Section, as Olaf S. Andersen and Arthur Gutierrez-Hartmann (outgoing and incoming Association President) were able to write to all NIH Institute Directors and propose an expansion of the F30 and F31 predoctoral National Research Service Award program to fund individual MD-PhD students. At the time, five NIH Institutes supported the F30 mechanism; a few Institutes instituted F30 Fellowships over the next year or so, and 23 Institutes provide F30 support in 2014 (PA-14-150).
The Section’s first accomplishment was the development of the long-sought common MD-PhD application on the American Medical College Application Service (AMCAS). This effort was moved forward expeditiously by Nancy Hall (Associate Dean of Student Affairs at University of Oklahoma) and Brian P. Sullivan (Administrative Director at the Washington University MSTP); the application was ready for the 2005-06 admissions cycle! Developing joint Traffic Rules for MD and MD-PhD admissions took longer. The effort, which was led by Olaf S. Andersen, was greeted positively by the AAMC Committee on Admissions because “there seemed to be as many ‘rules’ for MD-PhD admissions as there were Programs,” but faced some resistance from the Program Directors. These rules were established in time for the 2009-2010 admissions cycle.
The GREAT Group MD-PhD Section and National Association of MD-PhD Programs continue to coexist and synergize. The Section and Association have a joint leadership structure such that the Section Steering Committee Chair is also the Association President. Elections are coordinated by the AAMC. This arrangement offers maximum flexibility, allowing the Section to use programming and resources afforded by the AAMC and the Association to take up matters of training advocacy unique to MD-PhD programs. The MD-PhD training community (administrators and directors) meets in even years together with the GREAT Group and in odd years independently in conferences organized by the MD-PhD Association.
The author acknowledges Terence S. Dermody, Ruth Gotian, Arthur Gutierrez-Hartmann, and Brian Sullivan for their constructive suggestions for improving the text.
Presidents of the National Association of MD-PhD Programs
1997-2001 Paul A. Insel
2001-2003 M. Elizabeth Ross
2003-2005 Olaf S. Andersen
2005-2006 Arthur Gutierrez-Hartmann
2006-2007 Lawrence F. Brass
2007-2008 David M. Engman
2008-2009 Clayton A. Wiley
2009-2010 M. Kerry O’Banion
2010-2011 Myles Akabas
2011-2012 Robin G. Lorenz
2012-2013 Joseph T. Barbieri
2013-2014 Dianna M. Milewicz
2014-2015 Terence S. Dermody
2015-2016 Alan L. Goldin