3 Things I Wish I Knew Before Starting an MD-PhD Program
MD-PhD dual degree programs are seven to eight-year training programs that educate and prepare the next generation of physician scientists. The majority of MD-PhD programs are designated as Medical Scientist Training Programs (MSTPs), which are funded by the National Institutes of Health (NIH) and provide full tuition and a stipend to their students. Currently, there are approximately 50 MSTPs in the United States, with a total of ~500 positions, making them one of the most competitive programs in the country.
After conducting research in a biomedical laboratory and shadowing physician scientists on the hospital wards throughout high school and college, I knew I wanted my future career to combine research and medicine. But, like many things in life, the road to becoming a physician scientist is not a smooth one.
Here are three things I would tell the incoming class of 2020 MD-PhD students and those interested in becoming a physician scientist before they embark on this long journey:
1. Plan For Bumps in the Road
Like many students who enter an MSTP, I was a “type A” person. I planned my entire life ahead of me. My high school mentors encouraged me to pursue an MD-PhD dual degree, and after talking to more physician scientists, I outlined the steps I needed to take in order to apply and eventually get accepted into a program. Similarly, when I joined an MSTP, I wrote down my plan to graduate in seven years and match at a top residency program to become a renowned physician scientist:
- Crush the USMLE Step 1 and 2 Board Exams
- Be the most knowledgeable and helpful student on the wards
- Become a leader in several student organizations
- Attain my own funding in graduate school
- Pick an awesome mentor and publish like crazy in graduate school
But one thing is apparent in the list above: I did not plan for the unexpected. I cannot think of a single classmate who has not experienced an unexpected life event during the program. During my time as a MSTP student, I myself had several life-changing events:
- My mother was diagnosed with terminal cancer. To make matters worse, I was two thousand miles away from home. Being the only “doctor” in the family, I took breaks during long study sessions to talk to her oncologist and ask questions about her treatment plan over FaceTime. Since we were only allowed a few absences during the clinical years of medical school, it was extremely difficult to find time while studying for board exams and completing rotations on the wards to fly home to see my mother while she lived the final years of her life. One thing though that I realized was extremely important during this time: I had a supportive MSTP administrative team who supported me. You, too, may have a loved one diagnosed with a devastating illness in the next seven to eight years, and it will be necessary to take some time off to grieve and regroup. In order to do that, however, you need to have the support of your MSTP leadership team. Reach out to them early and often, even if it just to give an update about your life or have coffee together. They have invested a lot of time (and money!) into your training, and they are rooting for you every step of the way.
- I met my best friend and got married. I never thought I would meet somebody while I was in medical school. My mother ingrained in me from an early age that dating is a “distraction” from my studies and marriage can wait. But everything changed when I met my wife and fell deeply in love. And we just recently welcomed our first child! I can tell you for a fact that taking care of a screaming newborn at 2:30am is great training for your surgery clerkship when you’re operating on only two hours of sleep in the past forty-eight hours! But getting married and having a child during this program also helped me put into perspective the most important thing in life: family. First and foremost, you must take care of yourself, mentally and physically, and your family if you are to make it through this long program. They are your backbone and your support system that will be with you throughout the entire journey. Tell them you appreciate them every opportunity you get. It takes a village to get through this program!
- A once-in-a-century global pandemic has caused the world to come to a screeching halt. Laboratories were shut down. Medical students were pulled from the wards. USMLE postponed board exams. Watching the news coverage of hospitals inundated with COVID-19 patients while I sat at home in quarantine was excruciating to see. Why were we so underprepared for this pandemic? Why didn’t we heed the early warning signs? What are the ethical implications of treating patients without adequate personal protective equipment? What does the future of a practicing physician look like? Overall, watching the doctors treating patients on the frontlines and scientists racing to develop a vaccine and effective treatments for COVID-19 re-affirmed my decision to become a physician scientist. Physician scientists like Dr. Anthony Fauci are in demand more than ever —we need their experience both as clinicians and researchers to advance medicine and lead us during times of crises. You are the future leaders in medicine and science, and we need to do everything we can to maintain the physician scientist pipeline.
As one of my medical school mentors told me, medicine is a life-long learning experience: it doesn’t stop after medical school. You can try to plan out the next seven to eight years of your life, but there will undoubtly be wrenches thrown into your plan (but hey, if you can dodge a wrench, you can dodge a ball, right??). Embrace these challenges — they will certainly help you grow and become a better individual and a better physician scientist.
2. You Are Not the Smartest Person in the Class Anymore
Cue the imposter syndrome.
Remember those days in college when you could cram for the Chemistry midterm or Biology final exam the night before and ace it? Yeah, those days are gone. The amount of knowledge clinicians need to know today is unquantifiable. Some have compared medical school to “drinking from a fire hose.” While most medical schools have moved to a pass/fail grading system during the pre-clinical years, do you really want to be the doctor who just barely “passed” the exam on cardiac physiology? Who knew just enough on the anatomy practicals to squeeze by? Probably not.
I recall distinctly as a first year medical student being inundated with more than a hundred pharmaceutical drugs in a single two-hour cardiology lecture. For the upcoming end-of-the-week quiz, we needed to know their mechanisms of action, indications for use, pharmacokinetics, and potential side effects. There was just no way I could learn all of these drugs (plus the other material taught that week) before the quiz! That’s when I realized that the study strategies I brought with me from high school and college were not working. Indeed, you may have to change your study strategies in medical school! For example, although I always worked by myself in high school and college, I quickly realized that I could learn a lot more from my smart classmates! And that is when I started studying in small groups. It may take a few iterations to find a group that fits your study strategy, but once you find it, it will greatly increase your efficiency and retention of the material.
Just like you are not the smartest person in your medical school class, you will most likely not be the smartest person in graduate school. I recall sitting in numerous lab meetings and listening to my fellow graduate students and postdoctoral fellows in the lab present endless slides of data and rattle off findings from the latest Cell, Science, and Nature papers. How are they so productive? How are they able to keep up with the literature? And more importantly, why did I feel I was drowning in a pit of endless knowledge? Was I not working hard enough? While every graduate student can read more, nobody has the time to read every single new paper. So take advantage of the fact that your colleagues know more than you! Be attentive during lab meetings and learn from them. Use their knowledge and ask for help. If you don’t know how to do a certain technique, ask them to teach you. It is rare nowadays for papers to be published with only one author listed. Get them on your paper, and get your name on their papers! You’ll learn from them, they’ll learn from you, and all of you can add another skill or publication on your curriculum vitae!
3. Find Time to Have Fun
Of course, most of your time in this seven to eight-year program will be spent studying for board exams, qualifying exams, etc. As I mentioned before, there is a lot to learn! But do not forget about your own well-being. Take frequent breaks, step back, and reflect on what you are going through. You are getting both an MD and a PhD, something that only ~600 people achieve each year.
Although it may seem like you will never leave the library or the lab, you undoubtedly will attend conferences during your time in the program. There are plenty of conferences available for medical and graduate students. Often, your MD-PhD program, medical school, specialty interest groups, and/or graduate school will provide funding for you to attend (Tip: read your student handbook to find these funding sources!). Take advantage of these funding opportunities to attend conferences and expand your professional network. For example, the annual physician scientist meeting, held every April in Chicago, is a fantastic way to meet collaborators for your research, MSTP students from other programs, and even residency directors. If your MD-PhD program or thesis adviser cannot fund you, seek outside funding for these conferences. (Hint: you may need to even search outside your area of research or interests. I even received funding from the surgery department to present my basic cancer research at a conference!) And hey, while you’re there, don’t forget take an afternoon or evening to explore the city you’re in — you deserve a break every once in a while!
The seven to eight years in an MD-PhD program go by faster than you think. There will be a lot of highs, but there will also be a lot of lows. Don’t let those “lows” be the lasting memory of your time in the program. I don’t remember the late nights in the hospital, half aware of what was going on yet still trying to learn clinical pearls. I also don’t recall long study sessions in the library to prepare for the next exam or every failed experiment in graduate school. But looking back, I do remember the new friends I made and attending their weddings and Match Day ceremonies. I also remember taking care of my first cancer patient on the wards. And I will always remember the mentors who showed me the path on how to become the best physician scientist I could be. Good luck, and I hope to see you at a future conference when this pandemic is over!
