Qualitative research20 conducted with MD/PhD students identified one striking difference between these students and the general medical student population: the MD/PhD students almost universally made a decision to enter a research career well before they entered medical school, often as early as middle school and/or high school. They spoke of being exposed to grandparents or parents who were scientists, encountering physician-scientists during a health crisis of their own, or being excited by a high school biology teacher. They spoke of mentors they encountered during science courses in their undergraduate studies that convinced them that this career path was possible.
Similarly, interviews with deans at medical schools reported that students at their schools who expressed an interest in research typically developed that interest prior to their arrival in medical school. One dean suggested that the most important strategy to strengthen the biomedical workforce would be to foster students’ natural curiosity and excitement about science beginning in elementary school
Nonetheless, exposure to research during medical school increases students’ interest in research. Students graduating from medical school express more interest in research than students entering medical school, according to an AAMC study of students between 2006-2010. In this study, only 12.5 percent [Percent Error Corrected] of students expressed an interest in research when they entered medical school; that percentage had increased to 16.4 percent upon graduation. Further, approximately 45 percent of medical school graduates expect to be "somewhat involved" in research during their careers.21
Medical students from underrepresented racial/ethnic backgrounds who participated in the qualitative research indicated that they never considered a career in research because they knew nothing about it, having never encountered a physician-scientist as they were growing up. This point underscores the critical role of mentorship for both students and faculty.22 Recent reports have emphasized an intrinsic bias against women and minorities in mentoring as contributing to the disparities.23, 24
Financial pressures on these students reduced their interest in pursuing lengthy training in addition to obtaining an MD degree, as did the lower salaries they would earn as researchers. These students advocated for more programs that gave promising minority students exposure during high school and college to physician-scientists and to biomedical research.25
Paik, Howard, & Lorenz analyzed graduate placement data from NIH-funded MSTP programs from 2004 to 2008. They reported that the most common residencies for MSTP graduates were internal medicine (24.6 percent), pathology (10.3 percent), pediatrics (10 percent) and diagnostic radiology (6.9 percent). MSTP graduates were least likely to enter residencies in family medicine, emergency medicine, and obstetrics/gynecology.26 A 2013-2014 survey of MD/PhD trainees by the American Physician Scientists Association yielded similar results. Brass, et al. found in a 2010 review of 4 decades of outcomes data that nearly all (95 percent) MD/PhD program graduates enter clinical residencies. They also found that the proportion of graduates choosing clinical training in internal medicine, pediatrics, pathology and neurology declined from 73 percent for the 1965-1978 cohort to 57 percent for the 1999-2007 cohort.27
20 Appendix V contains a summary of qualitative research conducted to inform this PSW-WG
21 Courtesy of Ann Bonham, AAMC
22 Merchant J.L. & Omary M.B. (2010). Under representation of underrepresented minorities in academic medicine: The need to enhance the pipeline and the pipe. Gastroenterology, 138, 19-26
23 Moss-Racusin, C. A., Dovidio, J. F., Brescoll, V. L., Graham, M., & Handelsman, J. (in press, published online ahead of print). Science faculty’s subtle gender biases favor male students. Proceedings of the National Academy of Sciences, 109, 16474-16479.;
24 Milkman, K.L., Akinola, M. & Chugh, D. (2012). Temporal distance and discrimination: An audit study in academia Psychological Science 23(7), 710-717.
25 Of note, substantial efforts in this area are already in place through organizations such as Annual Biomedical Research Conference for Minority Students (ABRCMS), Society for Advancement of Chicanos and Native Americans in Science (SACNAS), the National Science Foundation, and the Ivy Plus consortium of universities, as well as the NIH-sponsored MARC U-STARS program that provides support for undergraduate students who are underrepresented in the biomedical and behavioral sciences to improve their preparation for high-caliber graduate training at the PhD level.
26 Paik, J.D., Howard, G., & Lorenz, R.G. (2009). Postgraduate Choices of Graduates from Medical Scientist Training Programs, 2004-2008. Journal of the American Medical Association, 302(12), 1271-1273.
27 Brass et al, ibid.