Launching a new fellowship for medical students: the first years of the Doris Duke Clinical Research Fellowship Program.

As part of its commitment to increasing the pipeline of physicians pursuing careers in clinical research, the Doris Duke Charitable Foundation launched the Doris Duke Clinical Research Fellowship (CRF) Program for medical students in 2000. The program, which is based at 10 US medical schools, provides medical students from any US medical school with the opportunity to spend 1 year obtaining both didactic and "hands-on" mentored clinical research experience. This article describes the program and summarizes the early outcomes collected during the first 3.5 years of the program. Interest in the program among medical students has been robust and widespread, with 35% of CRF program fellows matriculated at non-CRF schools. Exit surveys of the first three classes of fellows totaling 174 fellows indicated that (1) 97% of the fellows felt that participating in the fellowship was a good decision; (2) commitment to a career in clinical research was increased among the 44% of fellows reporting that they were unsure about pursuing a clinical research career when they began their fellowship; (3) there was no difference in satisfaction level between the fellows who remained at the medical schools in which they were matriculated and those who completed their fellowship at a medical school in which they were not matriculated; and (4) the majority of fellows responded that the didactic component of their fellowship was useful.     

The Canadian clinician-scientist training program must be reinstated

Clinical investigators within the Canadian and international communities were shocked when the Canadian Institutes of Health Research (CIHR) announced that their funding for the MD/PhD program would be terminated after the 2015–2016 academic year. The program has trained Canadian clinician-scientists for more than two decades. The cancellation of the program is at odds with the CIHR’s mandate, which stresses the translation of new knowledge into improved health for Canadians, as well as with a series of internal reports that have recommended expanding the program. Although substantial evidence supports the analogous Medical Scientist Training Program in the United States, no parallel analysis of the MD/PhD program has been performed in Canada. Here, we highlight the long-term consequences of the program’s cancellation in the context of increased emphasis on translational research. We argue that alternative funding sources cannot ensure continuous support for students in clinician-scientist training programs and that platform funding of the MD/PhD program is necessary to ensure leadership in translational research.The clinician-scientist community was shocked in June when the Canadian Institutes of Health Research (CIHR) announced that its funding for the MD/PhD program would be terminated. In a letter to MD/PhD program directors at Canadian medical schools, the CIHR cited budgetary constraints as the primary motivation for the cancellation of the program, which, at $1.8 million (all figures are in Canadian dollars), constitutes approximately 0.15% of the agency’s 2015 budget. Despite several internal reports that have recommended expanding clinical and translational research programs, and contrary to the CIHR’s own mandate, the CIHR has not yet outlined a new approach to clinician-scientist trainee program funding. Moreover, despite substantial evidence supporting American MD/PhD programs, no parallel evaluation of the MD/PhD program has been performed within Canada that would justify this funding decision (1). The cancellation of this program represents a blow to Canadian and international medical research.     

Strategies to Promote Nurses' Engagement in Clinical Research: Description of Two Nurse Scholar Programs

Innovative programs are needed to build a pipeline of future nurse scientists necessary to generate practice-based evidence for optimal healthcare and to address the serious shortage of PhD-prepared nurses. This paper describes two nurse scholar programs based in one large, Magnet® designated healthcare institution that aim to provide clinical registered nurses (RNs) with mentored research opportunities in order to ultimately build an internal pipeline of practice-based nurse scientists. The Clinical Nurse Scholar Program provides clinical RNs the opportunity to conduct a research study under the mentorship of a senior nurse scientist. The Nursing Research Scholar Program provides a clinical RN enrolled in a PhD program or who recently completed a PhD program with an opportunity to gain enhanced research training and acquire new research skills. These two scholar models have the potential to be replicated in other institutions to enhance the development of future nurse scientists and to address a critical national shortage of PhD-prepared nurse scientists.     

Challenging the exceptional student: A 3‐year honors program research elective

For students who excel academically during their first year in medical school, we offer an Honors Research Program that provides a 3‐year in‐depth research experience in addition to the medical curriculum. Applications are accepted and interviews conducted at the end of the first year. Students choose their own mentors and projects; however, the choice of mentor and an outline of the research must be approved by the Honors Program Committee. Annually, the candidates present their data at the Honors Program Colloquium and submit written progress reports. In addition, each senior gives a seminar and writes a thesis. A survey of graduates indicates that this program gave them a better understanding of research design and interpretation, assisted in obtaining residencies, and had a positive influence on career decisions in academic medicine. This program offers an alternative for students who are interested in an in‐depth research experience, but do not wish to pursue an MD/PhD pathway.     

Developing Future Clinician Scientists while Supporting a Research Infrastructure

Background

Supporting clinical research is a national priority. Clinician scientists are rare and clinical trials in academic medical centers (AMC) often fail to meet enrollment goals. Undergraduate students interested in biomedical careers often lack opportunities to perform clinical research.

Objective

Describe an innovative undergraduate course that supports clinical research in an AMC.

Methods

The course, Clinical Research Methods and Practice, offers undergraduate students the opportunity to learn clinical research through didactic and practical experiences. The students in turn support clinician scientists’ conduct of clinical studies in an AMC. Clinician scientists receive research support and participate in mentoring sessions for students.

Results

Over seven semesters, 128 students have assisted in 21 clinical studies located in outpatient and inpatient units of two hospitals. Students identified and screened eligible patients, collected clinical data, assisted in obtaining informed consent, and transported specimens. Many of the clinician scientists have met their enrollment goals and several have been top‐enrollers in multicenter clinical trials as a result of student support.

Conclusions

The Clinical Research Methods and Practice class addresses barriers to clinical research in AMC. This may be a model for institutions committed to mentoring students early in their career and to developing infrastructures for clinical research. Clin Trans Sci 2013; Volume 6: 94–97     

The Action Research Program: Experiential Learning in Systems-Based Practice for First-Year Medical Students

Problem: Systems-based practice focuses on the organization, financing, and delivery of medical services. The American Association of Medical Colleges has recommended that systems-based practice be incorporated into medical schools’ curricula. However, experiential learning in systems-based practice, including practical strategies to improve the quality and efficiency of clinical care, is often absent from or inconsistently included in medical education. Intervention: A multidisciplinary clinician and nonclinician faculty team partnered with a cardiology outpatient clinic to design a 9-month clerkship for 1st-year medical students focused on systems-based practice, delivery of clinical care, and strategies to improve the quality and efficiency of clinical operations. The clerkship was called the Action Research Program. In 2013–2014, 8 trainees participated in educational seminars, research activities, and 9-week clinic rotations. A qualitative process and outcome evaluation drew on interviews with students, clinic staff, and supervising physicians, as well as students’ detailed field notes. Context: The Action Research Program was developed and implemented at the University of California, San Francisco, an academic medical center in the United States. All educational activities took place at the university's medical school and at the medical center's cardiology outpatient clinic. Outcome: Students reported and demonstrated increased understanding of how care delivery systems work, improved clinical skills, growing confidence in interactions with patients, and appreciation for patients’ experiences. Clinicians reported increased efficiency at the clinic level and improved performance and job satisfaction among medical assistants as a result of their unprecedented mentoring role with students. Some clinicians felt burdened when students shadowed them and asked questions during interactions with patients. Most student-led improvement projects were not fully implemented. Lessons Learned: The Action Research Program is a small pilot project that demonstrates an innovative pairing of experiential and didactic training in systems-based practice. Lessons learned include the need for dedicated time and faculty support for students’ improvement projects, which were the least successful aspect of the program. We recommend that future projects aiming to combine clinical training and quality improvement projects designate distinct blocks of time for trainees to pursue each of these activities independently. In 2014–2015, the University of California, San Francisco School of Medicine incorporated key features of the Action Research Program into the standard curriculum, with plans to build upon this foundation in future curricular innovations.     

Clinical pharmacology education and training at the National Institutes of Health

In 1965, the National Institute of General Medical Sciences (NIGMS) established the intramural Pharmacology Research Associate Training (PRAT) program with the primary goals of providing postdoctoral training in pharmacology for individuals with or without previous pharmacology graduate training, and allowing individuals with doctoral degrees in pharmacology to obtain advanced training in other areas of science at the National Institutes of Health (NIH). The program utilized research preceptors drawn from laboratories that were conducting pharmacology-related research at the NIH campus. Although primary emphasis was placed on training laboratory scientists, a number of PRAT fellows obtained training that enabled them to pursue successful careers in clinical pharmacology. A partial listing of these individuals is shown in Table 1. Eventually, a clinical pharmacology training option was formalized within the PRAT program by the appointment of a Clinical Pharmacology Program Director, but this was subsequently suspended when this individual left NIH for a position in the pharmaceutical industry.     

Effectiveness of a Clinical Intervention for MD/PhD Students Re-entering Medical School

Background and Purpose: For MD/PhD students, the transition to medical school following graduate research can be difficult. We developed a clinical intervention, the Clinical Preceptorship Program (CPP), for MD/PhD students at Vanderbilt to ease the transition to the core clinical clerkship year (the 3rd medical year) following graduate training. In this study, we determined whether the CPP prepared MD/PhD students adequately for medical school reentry. Methods: Clerkship grades were obtained for 680 medical students and 50 MD/PhD students for academic years 2004–2010. A student's unpaired t test was used to analyze differences between group grades. Results: We did not detect significant differences in the grades of the MD versus MD/PhD students. No differences in individual clerkships were detected with the exception of the Surgery clerkship. Conclusions: These data suggest that the CPP intervention was successful in preparing MD/PhD students for the core clerkship year. Such a clinical intervention can be an effective preparation for MD/PhD students returning to medical school.     

A gender gap in the next generation of physician-scientists: medical student interest and participation in research.

BACKGROUND: For 2 decades, the number of physician-scientists has not kept pace with the overall growth of the medical research community. Concomitantly, the number of women entering medical schools has increased markedly. We have explored the effect of the changing gender composition of medical schools on the present and future pipeline of young physician-scientists. METHODS: We analyzed data obtained from the Association of American Medical Colleges, the National Institutes of Health, and the Howard Hughes Medical Institute pertaining to the expressed research intentions or research participation of male and female medical students in the United States. RESULTS: A statistically significant decline in the percentage of matriculating and graduating medical students--both men and women-who expressed strong research career intentions occurred during the decade between 1987 and 1997. Moreover, matriculating and graduating women were significantly less likely than men to indicate strong research career intentions. Each of these trends has been observed for medical schools overall and for research-intensive ones. Cohort data obtained by tracking individuals from matriculation to graduation revealed that women who expressed strong research career intentions upon matriculation were more likely than men to decrease their research career intentions during medical school. Medical student participation in research supported the gender gap identified by assessing research intentions. Female medical student participation in the Medical Scientist Training Program and the Howard Hughes Medical Institute/National Institutes of Health-sponsored Cloisters Program has increased but lags far behind the growth in the female population in medical schools. CONCLUSION: Three worrisome trends in the research career intentions and participation of the nation's medical students (a decade-long decline for both men and women, a large and persistent gender gap, and a negative effect of the medical school experience for women) presage a further decline in the physician-scientist pipeline unless they are reversed promptly and decisively.     

Innovative strategic Canadian research training from TomorrOw's Research Cardiovascular Health Care Professionals (TORCH)

Cardiovascular research training is experiential, and "skills" are traditionally acquired through a master-apprentice paradigm. The complexity of contemporary clinical research requires a new model for research training. Facilitated through a Strategic Training Program Initiative, the Canadian Institutes of Health Research (CIHR), with its partners the Alberta Heritage Foundation for Medical Research and the Heart and Stroke Foundation, supported the Universities of Alberta and Calgary to create a new and innovative training model. Tomorrow's Research Cardiovascular Health Professionals (TORCH) is an integrated 2-year program for health care professionals from diverse disciplines to be mentored toward careers as leaders in translational cardiovascular research, applying discovery to human health. This report describes the vision, mission, core values, objectives, design and curriculum of the program. Our vision is the development of a new generation of cardiovascular research clinician-scientists, with particular emphasis on thought, leadership and collaboration. The program incorporates 4 core values: innovation and discovery, a translational and transdisciplinary focus, an emphasis on collaboration and integration of research concepts, and the teaching of a core body of research knowledge coupled with real-world "survival" skills. The core curriculum, organized according to a cluster concept, traverses the 4 pillars of the CIHR. Through the medium of 1-hour weekly videoconferences, the curriculum cycles through case studies, seminars and a journal club in focused areas of cardiovascular research. Mentors in the TORCH program have diverse backgrounds that epitomize the transdisciplinary translational aspects of the program and are chosen for their proven record of research accomplishment and prior history of successful mentoring. The program has recruited 19 trainees from a broad cross-section of disciplines, integrating 2 University of Alberta campuses. The preliminary experience has been both favourable and gratifying.     

Summer Research Training for Medical Students: Impact on Research Self‐Efficacy

There is a well‐documented shortage of physician researchers, and numerous training programs have been launched to facilitate development of new physician scientists. Short‐term research training programs are the most practical form of research exposure for most medical students, and the summer between their first and second years of medical school is generally the longest period they can devote solely to research. The goal of short‐term training programs is to whet the students’ appetite for research and spark their interest in the field. Relatively little research has been done to test the effectiveness of short‐term research training programs. In an effort to examine short‐term effects of three different NIH‐funded summer research training programs for medical students, we assessed the trainees’ (N = 75) research self‐efficacy prior to and after the programs using an 11‐item scale. These hands‐on training programs combined experiential, didactic, and mentoring elements. The students demonstrated a significant increase in their self‐efficacy for research. Trainees’ gender, ranking of their school, type of research, and specific content of research project did not predict improvement. Effect sizes for different types of items on the scale varied, with the largest gain seen in research methodology and communication of study findings.     

Goal-directed fantasy does not explain the training effect of the carleton skills training package

Two treatments to enhance the hypnotic responsiveness of subjects who pretested as low in hypnotic susceptibility were compared. Subjects in one modification treatment (n = 20) received the Carleton Skills Training Package (CSTP). Those in a second modification treatment (n = 20) were administered a partial training that did not include information about imaginal strategies. The authors of the CSTP assume that goal-directed fantasies underlie subjects' feelings of invol-untariness, so teaching imaginal strategies is the primary agent of subjective changes after the training. Controls (n = 20) received no treatment. Both training packages enhanced behavioral and subjective response to an equivalent degree. Control subjects' performances were stable across tests. Modest increases in hypnotizability scores following training were related neither to enhancing goal-directed fantasies nor to use of imagery. Other mechanisms, possibly compliance, may underlie the CSTP effect.     

Making it meaningful: Teaching public health nursing through academic-community partnerships in a baccalaureate curriculum

Because of the importance, and difficulty, of providing public health clinical experiences for baccalaureate nursing students, a small midwestern school of nursing offered students a three-year assignment to agencies serving vulnerable populations. The program allowed for long-term placement of students, instilling in them an understanding of community health as a prime aspect of nursing care. Students mentored students, which enhanced continuity in the agencies. More than 2,000 community members have been served, and students' responses have been overwhelmingly positive.     

Disaster 101: A Novel Approach to Disaster Medicine Training for Health Professionals

Background: Despite efforts to improve preparedness training for health professionals, disaster medicine remains a peripheral component of traditional medical education in the United States (US) and is a rarely studied topic in the medical literature. Objectives: Using a pre-/post-test design, we measured the extent to which 4^th-year medical students perceive, rapidly learn, and apply basic concepts of disaster medicine via a novel curriculum. Methods: Via a modified Delphi technique, an expert curriculum panel developed a 90-min didactic training scenario and two 40-min training exercises for medical students: a hazardous material scene and a surprise mass casualty incident (MCI) scenario with 100 life-sized mannequins. Medical students were quizzed before and after the didactic training scenario about their perceptions and their disaster medicine knowledge. Results: Students rated their overall knowledge as 3.76/10 pretest compared to 7.64/10 after the didactic program. Students' post-test scores improved by 54% and students participating in the MCI drill correctly tagged 94% of the victims in approximately 10 min. The average overall rating for the experience was 4.85/5. Conclusions: The results of this educational demonstration project reveal that students will value and can rapidly learn some core elements of disaster medicine via a novel addition to a medical school's curriculum. We believe the principle of a highly effective and well-received medical student course that can be easily added to a university curriculum has been demonstrated. Further research is needed to validate core competencies and performance-based education goals for US health professional trainees.     

Development of an intensive simulating training program in emergency medicine for medical students in China

BACKGROUND: A national standardized emergency medicine(EM) curriculum for medical students, including specific competencies in procedural skills, are absent in many countries. The development of an intensive simulating training program in EM, based on a tight schedule, is anticipated to enhance the competency of medical students.METHODS: A 3-day intensive EM training program, consisting of four procedural skills and 8-hour case-based learning(CBL), was developed by experienced physicians from the EM department in Peking Union Medical College Hospital(PUMCH). Medical students from Peking Union Medical College(PUMC) and Tsinghua University(THU) participated in the training. Three written tests were cautiously designed to examine the short-term(immediately after the program) and long-term(6 months after the program) efficacy of the training. After completion of the training program, an online personal appraisal questionnaire was distributed to the students on WeChat(a mobile messaging App commonly used in China) to achieve anonymous self-evaluation.RESULTS: Ninety-seven out of 101 students completed the intensive training and took all required tests. There was a significant increase in the average score after the intensive simulating training program(pre-training 13.84 vs. 15.57 post-training, P<0.001). Compared with the pre-training test, 63(64.9%) students made progress. There was no significant difference in scores between the tests taken immediately after the program and 6 months later(15.57±2.22 vs. 15.38±2.37, P=0.157). Students rated a higher score in all diseases and procedural skills, and felt that their learning was fruitful.CONCLUSIONS: The introduction of a standardized intensive training program in EM focusing on key competencies can improve clinical confidence, knowledge, and skills of medical students toward the specialty. In addition, having such a program can also enhance student’s interest in EM as a career choice which may enhance recruitment into the specialty and workplace planning.     

Goal-directed fantasy does not explain the training effect of the Carleton Skills Training Package

Two treatments to enhance the hypnotic responsiveness of subjects who pretested as low in hypnotic susceptibility were compared. Subjects in one modification treatment (n = 20) received the Carleton Skills Training Package (CSTP). Those in a second modification treatment (n = 20) were administered a partial training that did not include information about imaginal strategies. The authors of the CSTP assume that goal-directed fantasies underlie subjects' feelings of involuntariness, so teaching imaginal strategies is the primary agent of subjective changes after the training. Controls (n = 20) received no treatment. Both training packages enhanced behavioral and subjective response to an equivalent degree. Control subjects' performances were stable across tests. Modest increases in hypnotizability scores following training were related neither to enhancing goal-directed fantasies nor to use of imagery. Other mechanisms, possibly compliance, may underlie the CSTP effect.     

An educational course including medical simulation for early goal-directed therapy and the severe sepsis resuscitation bundle: An evaluation for medical student training

Objective

Widespread application of early goal-directed therapy (EGDT) and the severe sepsis resuscitation bundle is limited by clinician knowledge, skills and experience. This study evaluated use of simulation-based teaching during medical training to increase future clinician knowledge in the above therapies for severe sepsis and septic shock.

Methods

A prospective cohort study was performed with medical students at all levels of training. A 5-h course including didactic lectures, skill workshops, and a simulated case scenario of septic shock were administered to the participants. A checklist including 21 tasks was completed during the patient simulation. An 18-question pre-test, post-test and 2-week post-test were given. The participants completed a survey at the end of the course.

Results

Sixty-three students were enrolled. There was statistical difference between the pre-test and each of the post-test scores: 57.5 ± 13.0, 85.6 ± 8.8, and 80.9 ± 10.9%, respectively. 20.6% of participants thought the pre-test was too difficult, whereas all participants thought the post-test was either appropriate or too easy. The task performance during the simulated septic shock patient was 94.1 ± 6.0%. The participants noted improvements in their confidence levels at managing severe sepsis and septic shock, and agreed that the course should be a requirement during medical school training.

Conclusions

Medical simulation is an effective method of educating EGDT and the severe sepsis resuscitation bundle to medical students with limited experience in patient care. The results suggest that our course may be of further benefit at increasing clinical experience with this intensive protocol for the management of severe sepsis and septic shock.     

Impact of medical student research in the development of physician-scientists.

CONTEXT: A decline in the number of physician-scientists has been identified in the United States for at least two decades. Although many mechanisms have been proposed to reverse this trend, most of these have concentrated on MD/PhD programs, research in sub-specialty fellowships, and other approaches later in physician training. Few have emphasized early medical student research experiences as a contributing solution. OBJECTIVE: To determine the effect of a medical student research experience on career choices and attitudes about biomedical research. DESIGN, SETTING, AND PARTICIPANTS: We jointly report 25 years of experience with National Institutes of Health (NIH)-sponsored Medical Student Research Fellowship programs (MSRFs) at two colleges of medicine, the University of Tennessee Health Science Center and Vanderbilt University. In both programs, students work during the summer of their first or second year of medical school on a research project that is mentored by an established scientist and participate in a structured program (lectures, visiting professor). MAIN OUTCOME MEASURES: We gathered data using pre- and postresearch fellowship questionnaires to assess (a) quality of research experiences; (b) tabulation of productivity, that is, presentations, abstracts, publications, and awards; (c) long-term tracking of former program participants; (d) comparison of residency placements by medical student researchers; and (e) comments from former program participants on the effects of their students' research experiences on career choices. RESULTS: During this time, approximately 1,000 medical students participated in the two programs. Follow-up data (for short-term evaluations, 96-132 respondents with a response rate > 82%; for long-term evaluations, 88-118 respondents with a response rate > 29-33%) strongly suggest (a) interest in an academic career increased, (b) one-third to half of former student respondents considered themselves to be in academic medicine, (c) the vast majority of students conducted additional research after their medical student research experience, and (d) a large number of students were currently doing research or had published or presented their work at scientific meetings. CONCLUSIONS: Over two decades of experience with NIH-sponsored medical student research programs at two medical schools strongly support the ability of these programs to interest medical students in research and academic careers. MSRFs should be included in strategies to reverse the decline in the number of physician-scientists.     

Doris Duke Clinical Research Fellowship: report of the second annual meeting.

The second annual national meeting of the Doris Duke Charitable Foundation Clinical Research Fellowship for Medical Students program was held June 24 to 26, 2003, at Cold Spring Harbor Laboratory near Long Island Sound. This 3-day meeting offered an opportunity for 63 of the 2002 Doris Duke clinical research fellows, program directors, administrators, and invited physician-scientists to present and share their research with one another in an informal, inspiring setting at an institution with a history that mirrors the development of modern American medical research. Following a keynote lecture by Dr. Kenneth Davis, dean of the Mount Sinai School of Medicine, six physician-scientists representing different areas of clinical research presented their work. Oral and poster presentations by the Doris Duke fellows of their research were interspersed throughout the meeting and comprised its central focus. The fellows' research spanned a broad spectrum of clinical research from studies translating basic research findings to those addressing clinical questions to epidemiologic and health outcomes studies. The meeting culminated in a forum entitled "'Where Do We Go from Here?' Residency Selection and Further Research Training in Pursuit of a Career as a Clinician-Scientist," which was moderated by this year's clinical research fellow national program leader, Dr. Allyn L. Mark. The meeting celebrated the accomplishments of these talented medical students during their fellowship year and, it is hoped, instilled in them awareness that their continued efforts are important to the future progress of medicine.